G-poem assisted by marking the tunnel pathway to the pylorus via a preemptive submucosal injection with a viscous solution all the way to the pylorus in order to avoid swirling

Abstract Text A 65-year-old male with a history of hiatal hernia repair complicated with postoperative gastroparesis (large gastric food bezoars on endoscopy, gastric emptying of 14% at 4 hours). His GCSI score was 2.8. Hemoglobin A1c 6.8.

Endoscopy showed food bezoars that were cleaned and a spastic pylorus.

In order to avoid swirling away from the pylorus, a preemtive submucosal injection with a blue viscous solution was done starting from the pylorus and ending 3 cm proximally. A horizontal mucosal incision was performed followed by submucosal dissection following the blue viscous solution until the pylorus was reached. Two full-thickness myotomies were performed. The tunnel entry was closed using an endoscopic suturing device. [1]

His symptoms remarkably improved (GCSI went down to 0.2).

Video http://data.process.y-congress.com/ScientificProcess/Data//106/474/1197/95d2b8ef-432b-47a2-97b1-c4e854b8b11e/Uploads/13821_G_poem%20series%202.mp4

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Kolb JM, Sowa P, Samarasena J. et al. Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus). VideoGIE 2022; 7 (02) 82-84

Publication History

Article published online:
15 April 2024