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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E832-E839
DOI: 10.1055/a-1797-9587
Original article

Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Yervant Ichkhanian
1   Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan, United States
,
Joo Ha Hwang
2   Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
,
Andrew Ofosu
2   Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
,
Andrew A Li
2   Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
,
Daniel Szvarca
3   Johns Hopkins Hospital, Department of Internal Medicine, Baltimore, Maryland, United States
,
Peter V. Draganov
4   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Dennis Yang
4   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Eva Alsheik
5   Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
,
Tobias Zuchelli
5   Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
,
Cyrus Piraka
5   Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
,
Shruti Mony
6   Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Mouen A. Khashab
6   Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
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Abstract

Background and study aims Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients.

Patents and methods This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events.

Results A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5–13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3–17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing.

Conclusions G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.

Supplementary material



Publication History

Received: 25 November 2021

Accepted after revision: 17 February 2022

Article published online:
10 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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