Is G-Poem of any value in clinical practise?

Aims The objective of this study is to assess the effectiveness, safety profile, and durability of outcomes associated with G-POEM for patients experiencing refractory gastroparesis, with a focus on symptom relief, quality-of-life enhancement, and procedural safety. G-POEM is a new, minimally invasive endoscopic procedure primarily used to treat gastroparesis. The technique involves creating a submucosal prepyloric gastric tunnel and performing a myotomy on the pyloric sphincter to enhance gastric emptying. Indications for G-POEM include refractory gastroparesis unresponsive to medical therapy, which may present as idiopathic, diabetic, or postsurgical in origin. Patients typically experience symptoms such as nausea, vomiting, early satiety, bloating, and abdominal pain. By targeting the pylorus, G-POEM aims to improve gastric emptying and alleviate these symptoms.

Methods G-POEM has been performed in adults at the University Hospital of North Midlands Trust since July 2021. Prospectively collected G – POEM data from hospital electronic patient records have been reviewed. In total, 7 patients underwent G-POEM procedures between 2021 and 2024. The median age of the participants in this study cohort was observed to be 41. The gender distribution within this study cohort comprised of 43% males and 57% females. Measured outcomes included: technical success, length of stay, clinical success and changes to weight.

Results The procedure was technically successful in all patients. The median length of hospital stay was 0 days (from 0–12 days), with no 30 day post operative mortality. 1/7 patients had emergency laparoscopy for suspected leak which confirmed secure mucosal closure. Only 1/7 patients who had diabetic gastroparesis reported significant clinical benefit with improved symptoms and weight gain. This shows that GPOEM had 14.3% success in terms of clinical efficacy. 85.7% of patients remains symptomatic with 28.6% of participants reporting no improvements in symptoms from pre-operative assessment to post-operative follow up of 3-months. In terms weight changes, 28.6% showed a positive result of having gained weight, but 14.3% lost weight.

Conclusions G-POEM procedure has not demonstrated significant short-term benefits for patients with refractory Gastroparesis. From our study, we can conclude that, the procedure has provided symptomatic relief in limited number of patients, it had no significant impact on the quality of life in majority of patients. Upto a third of patients have gained weight post procedure. Given the findings with our data, we need to look at methods to identify patients who might benefit from the procedure who appear to be select group of patients with diabetic gastroparesis. We recommend further research to evaluate efficacy of G-POEM and identify patients who will benefit from G-POEM as treatment options for gastroparesis are very limited.

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Artikel online veröffentlicht:
27. März 2025