Jean-Michel Gonzalez1, Valentin Lestelle1, Alban Benezech1, Jonah Cohen2, Véronique Vitton3, Jean-Charles Grimaud1, Marc Barthet1. 1. Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France. 2. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 3. Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France; Aix-Marseille Université, Interface de recherche translationnelle en neurogastroentérologie, CRN2M, UMR 7286, Marseille, France.
Abstract
BACKGROUND AND AIMS: Gastroparesis is a chronic, debilitating condition. We report an experience conducting gastric per-oral endoscopic pyloromyotomy (G-POEM) with objectives to assess clinical efficacy, gastric emptying evolution, and procedural adverse events. METHODS: This was a clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015. Patients included had severe disease as defined by elevated Gastroparesis Cardinal Symptoms Index (GCSI) score and delayed gastric emptying scintigraphy (GES). G-POEM was performed by mucosal incision upstream the pylorus followed by submucosal tunnel and antropyloromyotomy with subsequent access closure. Efficacy was assessed at 5 days, 1 month, and 3 months, based on GCSI score, and individualizing (Likert scale) the main symptoms (nausea, vomiting, abdominal pain, early satiety, and anorexia). GES was performed 2 months after the procedure. RESULTS: G-POEM was successfully performed in all 12 patients, yielding a technical success rate of 100%. Significant improvements in GCSI were observed: 3.5 ± .8 versus .9 ± .9 (1 month) and 1.1 ± 1.5 (3 months), respectively (P < .001), as well as the severity of main symptoms at 3 months. Clinical efficacy was 85% (10/12). GES normalized in 75% of cases, with improvement of half emptying time (222 ± 90 minutes vs 133 ± 90 minutes; P = .03) and retention at 2 hours (76% ± 20% vs 44% ± 26%; P = .009). There were no adverse events related to the procedure. CONCLUSION: We report a single-center study evaluating G-POEM for refractory gastroparesis, demonstrating its feasibility, reproducibility, and safety with promising clinical and scintigraphic efficacy.
BACKGROUND AND AIMS: Gastroparesis is a chronic, debilitating condition. We report an experience conducting gastric per-oral endoscopic pyloromyotomy (G-POEM) with objectives to assess clinical efficacy, gastric emptying evolution, and procedural adverse events. METHODS: This was a clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015. Patients included had severe disease as defined by elevated Gastroparesis Cardinal Symptoms Index (GCSI) score and delayed gastric emptying scintigraphy (GES). G-POEM was performed by mucosal incision upstream the pylorus followed by submucosal tunnel and antropyloromyotomy with subsequent access closure. Efficacy was assessed at 5 days, 1 month, and 3 months, based on GCSI score, and individualizing (Likert scale) the main symptoms (nausea, vomiting, abdominal pain, early satiety, and anorexia). GES was performed 2 months after the procedure. RESULTS: G-POEM was successfully performed in all 12 patients, yielding a technical success rate of 100%. Significant improvements in GCSI were observed: 3.5 ± .8 versus .9 ± .9 (1 month) and 1.1 ± 1.5 (3 months), respectively (P < .001), as well as the severity of main symptoms at 3 months. Clinical efficacy was 85% (10/12). GES normalized in 75% of cases, with improvement of half emptying time (222 ± 90 minutes vs 133 ± 90 minutes; P = .03) and retention at 2 hours (76% ± 20% vs 44% ± 26%; P = .009). There were no adverse events related to the procedure. CONCLUSION: We report a single-center study evaluating G-POEM for refractory gastroparesis, demonstrating its feasibility, reproducibility, and safety with promising clinical and scintigraphic efficacy.
Authors: H B Xue; H Z Fan; X M Meng; S Cristofaro; P Mekaroonkamol; S Dacha; L Y Li; X L Fu; S H Zhan; Q Cai Journal: Surg Endosc Date: 2017-04-13 Impact factor: 4.584
Authors: Matthew T Allemang; Andrew T Strong; Ivy N Haskins; John Rodriguez; Jeffrey L Ponsky; Matthew Kroh Journal: J Gastrointest Surg Date: 2017-07-27 Impact factor: 3.452
Authors: John H Rodriguez; Ivy N Haskins; Andrew T Strong; Ryan L Plescia; Matthew T Allemang; Robert S Butler; Michael S Cline; Kevin El-Hayek; Jeffrey L Ponsky; Matthew D Kroh Journal: Surg Endosc Date: 2017-05-31 Impact factor: 4.584