Initial Experience with Endoscopic Pyloromyotomy, with Description and Video of Technique.

BACKGROUND

Gastric per oral endoscopic myotomy (G-POEM) is a recently developed incisionless procedure to address gastroparesis. It has been previously described to treat medical and postsurgical gastroparesis. The present study is a case series of patients undergoing G-POEM for a variety of indications, both elective and urgent.

METHODS

IRB approval was obtained for retrospective review of a prospectively collected database including patients who underwent G-POEM during a 1.5-year period. Using an upper endoscope, a mucosotomy is made 2 cm proximal to the pylorus on the anterior surface of the stomach. A submucosal tunnel is made to the pylorus muscle, which is completed incised. When possible, Endoflip® was used to evaluate pyloric distensibility before and after the myotomy. Patient demographic factors, additional procedures, and other follow-up were collected by chart review. Elective cases were offered repeat gastric emptying study at 6 months.

RESULTS

There were 17 patients available for review. The procedure was technically completed in all cases. There was one gastric perforation recognized on postoperative day two that was addressed with laparoscopy and omental patch. Median length of stay was zero days, and 13/17 (76%) of patients experienced symptomatic relief. Pyloric distensibility significantly decreased intraoperatively from 5.6 (± 1.7) to 10.8 (± 5.0) cm2/mmHg (p = 0.002).

CONCLUSION

This limited case series demonstrates G-POEM to be a versatile procedure able to address gastroparesis in a variety of settings. Success rates are congruent with previously published reports, and one serious complication was able to be addressed laparoscopically. Endoflip® was able to verify a successful myotomy intraoperatively. This procedure is an attractive alternative to less effective non-invasive treatments and a more invasive laparoscopic pyloroplasty.