PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) FOR THE TREATMENT OF REFRACTORY GASTROPARESIS

Aims:

G-POEM is a new promising method for the treatment of refractory gastroparesis (GP). So far, small studies have been published suggesting its short-term efficacy and low incidence of periprocedural complications, but more data is necessary to assess the real role of G-POEM in clinical practice. The aim of our pilot study was to assess long-term (more than 12 months) clinical effectiveness, safety and technical aspects of G-POEM in consecutive patients with refractory GP.

Methods:

All patients with Gastroparesis cardinal symptom index (GCSI) > 2.3 and abnormal gastric emptying study (GES) were included. Main outcomes were a) the proportion of patients with treatment success (defined as a decrease of a total GSCI score of at least 40%) at 3, 12 and 24 M and b) incidence of adverse events.

Results:

G-POEM was performed in 9 patients (5 women) with the following etiologies of GP: 5 post-surgical, 2 diabetics, 1 idiopathic, 1 combined post-surgical and diabetic and all were successfully completed. Treatment success was achieved in 8/9 patients (88.9%) at 3, 12 and 3/4 (75%) at 24 M. The mean GSCI score decreased from 3.3 ± 0.8 to 1.0 ± 0.3 (p < 0.001), 1.0 ± 0.7 (p = 0.02) and 1.4 ± 0.9 (p = 0.15) at 3, 12 and 24 M after the procedure. In those patients with a treatment success, no recurrences have occurred so far. In one patient, there was a leak on POD1 and he needed additional clips to safely close the incision. One patient experienced delayed bleeding from gastric ulceration, which was successfully treated endoscopically, all remaining patients recovered uneventfully. GES improved/normalized in all patients.

Conclusions:

G-POEM was effective in 88.9% of patients and the effect seems long-lasting. (Supported by a grant from the Czech Ministry of Health 17 – 28797A).