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>> Gastroparesis is a common disorder.
Etiologies include diabetes, post surgical and idiopathic.
There are limited available therapies for gastroparesis.
Gastric Peroral Endoscopic Myotomy
was described six years ago
to treat patients with refractory gastroparesis.
This procedure entails performing
a minimally invasive endoscopic surgery
in the endoscopy unit
with the intention of treating a spastic pylorus.
It is thought that a certain proportion
of patients with gastroparesis
have spastic pylorus sphincter.
The pylorus sphincter is a sphincter
at the end of the stomach that opens and closes
to allow food to exit the stomach.
In a certain proportion of patients with gastroparesis,
the pylorus muscle is spastic.
So G-POEM procedure focuses on treating pylorus spasm.
This is a video illustrating
an actual Gastric Peroral Endoscopic Myotomy procedure.
After the endoscope is advanced to the stomach,
we perform what we call tunneling.
The endoscope is advanced to within the wall
of the gastric antrum.
Few centimeters proximal to the pylorus muscle.
Tunneling is performed using a standard ESD knife.
And then tunneling in discontinued
until we reach the pylorus muscle.
The pylorus muscle is a distinct structure
because it appears like a thick muscular ring.
Once the pylorus muscle is reached,
then the intention will be
to perform a complete pyloromyotomy
and again using an ESD knife.
Using an ESD knife, as we can see in this video,
a complete pyloromyotomy is performed
and this will result in relaxation of the pylorus sphincter
and thus improvement in gastric emptying.
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G-POEM procedure takes about 45 minutes to complete.
Patients are typically admitted
to the hospital for observation.
Procedure is pretty safe
and serious adverse events are extremely uncommon.
Specifically, complication of dumping syndrome
and severe symptomatic bile reflux
through the relaxed pylorus sphincter
are very uncommon with G-POEM.
And this is in contrast to surgical pyloroplasty
where these important side effects
or complications are more common.
In terms of the long term outcomes
of Gastric Peroral Endoscopic Myotomy
82% of patients will experience significant improvement
in their symptoms.
And this varies from complete resolution
to partial resolution of symptoms.
About 18% of patients will not respond to the procedure.
In terms of gastric emptying,
about two thirds of patients will show improvement
in their gastric emptying on repeat testing.
And this varies from complete normalization
of gastric emptying to significant improvement
in stomach emptying on repeat testing.
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