GASTRIC PERORAL ENDOSCOPIC MYOTOMY (G-POEM) – FIRST EXPERIENCE

Aims:

Gastroparesis is defined as delayed stomach emptying in the absence of obstruction. Symptoms include vomiting, nausea, post-prandial fullness, epigastric pain, weight loss and early satiety. Etiology varies between post-surgical injury of the vagus nerve, diabetes mellitus or medication, yet one third of the cases are idiopathic.

Methods:

This is a retrospective single center case series of 8 patients treated with G-POEM. All patients received a gastric emptying scintigraphy (GES) and a 13C-octanoic acid breath test before the procedure. POEM was perfomed using a triangle knife with water jet function (Olympus) and HF-generator (VI0 300D, ERBE) and a distal cap on the endoscope (Olympus, Distal Attachement, Ø12,4 mm). The first step was to inject 5 ml of saline with indigocarmine at the greater curvature in the antrum in a distance of 4 cm to the pylorus. A small incision of 10 – 15 mm of the mucosa was performed (EndoCut-Q) and subsequently submucosal injection was performed. Tunneling in the submucosa was performed until the muscle of the pylorus was visible. The pylorus was cut over a length of 1 cm (EndoCut-Q). Finally, the incision was closed by using through-the-scope (TTS) clips (Olympus, standard clip).

Results:

In all 8 cases, G-POEM was technically successful. The mean age of patients was 55 years. The etiology of gastroparesis was post-surgical in 6 cases and idiopathic in 2 cases.

The mean procedure duration was 112 minutes (range 39 to 159). Technical success was 100%. The closure with TTS clips was successful in all cases. No acute complications occured. Six out of 8 patients had clinical improvement within 3 months. Mean GES time decreased from 33 minutes preoperative to 14 minutes after G-POEM.

Conclusions:

G-POEM seems to be a safe and promising treatment option for gastroparesis, if indication was chosen carefully. However, long-term follow-up and randomized trials are necessary to evaluate this new technique.