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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E139-E144
DOI: 10.1055/a-2211-8903
Original article

Mid-gastric peroral endoscopic myotomy in the treatment of post-sleeve gastrectomy gastric tube twist: Four cases

Angelique Mugnier
1   Hôpital Nord, Gastroenterologie, AP-HM, Marseille, France (Ringgold ID: RIN36900)
,
Veronique Vitton
1   Hôpital Nord, Gastroenterologie, AP-HM, Marseille, France (Ringgold ID: RIN36900)
,
Marc Barthet
1   Hôpital Nord, Gastroenterologie, AP-HM, Marseille, France (Ringgold ID: RIN36900)
,
Jean-Michel Gonzalez 
1   Hôpital Nord, Gastroenterologie, AP-HM, Marseille, France (Ringgold ID: RIN36900)
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Abstract

Background and study aims Laparoscopic sleeve gastrectomy (LSG) may lead to symptomatic mid-gastric twist in 0.1% to 4% of cases. Endoscopic balloon dilatation often fails, requiring a switch to Roux-en-Y bypass. Submucosal endoscopic treatment is expanding, so we propose a new technique of fibrosis incision after tunnelization, called medio-gastric peroral endoscopic myotomy (MG-POEM).

Patients and methods Four patients aged 41 to 70 years underwent MG-POEM in 2020 for symptomatic post-LSG medio-gastric twist. The aim was to describe the technique, and document the efficacy, using the Gastric Outlet Obstruction Scoring System (GOOSS) score and a quality-of-life scale (QOLS). The procedures consisted of a POEM with myotomy and fibrosis incision.

Results Median preoperative GOOSS and QOLS were 1/3 ([0–3] and 1.75/10 [0–10], respectively. All procedures were technically successful. One patient had immediate postoperative complications, which were treated conservatively. The median follow-up was 18 months. All patients had improved quality of life and food intake, with median postoperative GOOSS and QOLS of 3/3 and 6,5/10 [6–8], respectively. Two patients required additional pneumatic dilatation for scarring strictures. Follow-up endoscopies and esophagograms showed that the twist had disappeared.

Conclusions MG-POEM shows promise for safe and effective management of post-LSG mid-gastric twist, despite requiring a high level of endoscopic skill to perform submucosal tunneling.

Keywords

POEM - GI surgery - Benign strictures


Publication History

Received: 03 May 2023

Accepted after revision: 08 November 2023

Article published online:
30 January 2024

© 2024. 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/).

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(04): 321-321
DOI: 10.1055/a-2241-6227

 

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