Endoscopy 2018; 50(11): 1053-1058
DOI: 10.1055/a-0596-7199
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience

Michel Kahaleh
1  Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
,
Jean-Michel Gonzalez
2  Aarhus University, Marseille, France
,
Ming-ming Xu
3  Gastroenterology, Southern California Permanente Medical Group, Los Angeles, California, USA
,
Iman Andalib
4  Weill Cornell Medical Center, New York, New York, United States
,
Monica Gaidhane
1  Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
,
Amy Tyberg
1  Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
,
Monica Saumoy
4  Weill Cornell Medical Center, New York, New York, United States
,
Alberto Jose Baptista Marchena
5  Hospital de Clínicas Caracas, San Bernardino, Venezuela
,
Marc Barthet
2  Aarhus University, Marseille, France
› Author Affiliations
Further Information

Publication History

submitted 19 June 2017

accepted after revision 23 February 2018

Publication Date:
12 April 2018 (eFirst)

Abstract

Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM.

Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure.

Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 – 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 – 14 days). The mean follow-up duration was 11.5 months (2 – 31 months).

Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.