GASTRIC PER ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM): A RETROSPECTIVE SINGLE-CENTER EXPERIENCE

Aims:

Evaluate the safety and the efficacy of G-POEM as a treatment of patients with gastroparesis and refractory symptoms.

Methods:

Patients who were intended to benefit from G-POEM from January 2015 to Novembre 2018. Symptoms were assessed with the Gastroparesis Cardinal Symptoms Index (GCSI) score. Gastric Emptying was evaluated with scintigraphy (GES) half gastric emptying time (HGET), Retention Percentage at 2 Hours (RPH2). Statistical evaluation was carried out using the software SPSS. Statistical difference is determined with the Wilcoxon Signed Ranks Test, with P < 0.05 considered as significant. Data are presented as medians with minimum and maximum.

Results:

23 patients were treated. GES was delayed in all patients, median HGET was 143.5 min (101 – 802, n = 13) and RPH2 58.5% (40 – 104, n = 14). Follow-up was 3 months (1 – 24, n = 22). Aetiologies were diabetic in 13% of patients (n = 3), post surgical in 30% (n = 7), idiopathic in 30% (n = 7), post oesophago-gastrectomy in 26% (n = 6). Median duration of symptoms was 26 months (2 – 149). Median age was 55 years (17 – 73, n = 23), with 74% female (n = 17) and 26% male subjects (n = 6). Previous therapies included Botox injection in 39% of patients (n = 9), and Surgical jejunostomy in 13% of patients (n = 3). G-POEM was completed successfully in 22 patients (95,65%) with one failure due to fibrosis and thus no access to submucosal space. They were 3 immediate complications and no delayed complications (1 bulbar perforation, 1 gastric perforation and 1 hemorrhage) all managed endoscopically. Median length of myotomy was 2 cm (1 – 3, n = 12). Median GCSI before and after treatment were 4 (2.78 – 5, n = 11) and 2.11 (0.44 – 4.44, n = 13). GCSI was compared before and after treatment in 10 patients and were significantly improved (p = 0,022). GES were obtained in 14 patients at 3 months (1 – 10), with a significant reduction of RPH2 and HGET (p = 0.003 and 0.016).

Conclusions:

These retrospective data suggest that G-POEM is a technically feasible and safe procedure.