Endoscopic Pyloromyotomy Through Mature Gastrostomy for Refractory Gastroparesis in Complex Surgical Anatomy.

Gastroparesis is a progressive disorder that significantly impairs quality of life. While its pathogenesis is multifactorial, pylorospasm is thought to play a critical role. Gastric peroral endoscopic myotomy has emerged as a minimally invasive treatment of refractory gastroparesis. A 17-year-old adolescent boy with a medical history of Lennox-Gastaut syndrome, cerebral palsy, and a recent admission for septic shock was transferred to our facility for management of a nonfunctional gastrostomy tube, refractory gastroesophageal reflux, and a post-Nissen fundoplication hiatal hernia. This case illustrates the feasibility of performing pyloromyotomy through an existing gastrostomy stoma to manage refractory gastroparesis in patients with significant anatomical constraints. Endoscopic pyloromyotomy through gastrostomy stomas represents a viable alternative when the conventional peroral approach is not feasible due to anatomical variations.