Fluoroscopy-guided Gastric Peroral Endoscopic Pyloromyotomy (G-POEM): a More Reliable and Efficient Method for Treatment of Refractory Gastroparesis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2017 Apr 15

PMID 28409375

Citations 18

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

Affiliations

Soon will be listed here.

Abstract

Introduction: Prior studies show promising results of the gastric peroral endoscopic pyloromyotomy (G-POEM) procedure for treatment of refractory gastroparesis. One major technical challenge involved in this procedure is identifying the pyloric muscular ring (PMR). The aim of this study is to establish a reliable method for identification of the PMR during G-POEM.

Methods: Fluoroscopy-guided G-POEM was performed by placing an endoclip at the 9 to 11'o clock position at the pylorus for identification of PMR. Conventional G-POEM was performed by observation of blue colored mucosa at the pylorus area as an indirect marker for PMR. The degree of the PMR identification was graded into well identified, identified, and not identified based on the appearance of the PMR. Procedure times were accurately documented. Gastroparesis cardinal symptoms index and gastric emptying scintigraphy were evaluated before and after the procedure.

Results: Fourteen patients were studied, seven underwent fluoroscopy-guided G-POEM, and seven patients underwent conventional G-POEM. All procedures achieved technical success and no adverse events occurred. In the seven patients who underwent fluoroscopy-guided G-POEM, the PMR was well identified in four patients and identified in three patients. In the seven patients who underwent conventional G-POEM, the PMR was identified in four patients and not identified in three patients. The average time to complete the fluoroscopy-guided G-POEM was significantly shorter than that of the conventional G-POEM.

Conclusions: Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.

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References

Mekaroonkamol P, Li L, Dacha S, Xu Y, Keilin S, Willingham F . Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes. Neurogastroenterol Motil. 2016; 28(8):1272-7. DOI: 10.1111/nmo.12854. View

Mekaroonkamol P, Li L, Cai Q . The role of pyloric manometry in gastric per-oral endoscopic pyloromyotomy (G-POEM): response to Jacques et al. Neurogastroenterol Motil. 2016; 29(1). DOI: 10.1111/nmo.12949. View

Park M, Camilleri M . Gastroparesis: clinical update. Am J Gastroenterol. 2006; 101(5):1129-39. DOI: 10.1111/j.1572-0241.2006.00640.x. View

Shlomovitz E, Pescarus R, Cassera M, Sharata A, Reavis K, Dunst C . Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc. 2014; 29(3):543-51. DOI: 10.1007/s00464-014-3720-6. View

Gonzalez J, Lestelle V, Benezech A, Cohen J, Vitton V, Grimaud J . Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc. 2016; 85(1):132-139. DOI: 10.1016/j.gie.2016.07.050. View

Gonzalez J, Vanbiervliet G, Vitton V, Benezech A, Lestelle V, Grimaud J . First European human gastric peroral endoscopic myotomy, for treatment of refractory gastroparesis. Endoscopy. 2015; 47 Suppl 1 UCTN:E135-6. DOI: 10.1055/s-0034-1391821. View

Clarke J, Snape Jr W . Pyloric sphincter therapy: botulinum toxin, stents, and pyloromyotomy. Gastroenterol Clin North Am. 2015; 44(1):127-36. DOI: 10.1016/j.gtc.2014.11.010. View

Chaves D, de Moura E, Mestieri L, Artifon E, Sakai P . Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion. Gastrointest Endosc. 2014; 80(1):164. DOI: 10.1016/j.gie.2014.03.045. View

Jung Y, Lee J, Gromski M, Kato M, Rodriguez S, Chuttani R . Assessment of the length of myotomy in peroral endoscopic pyloromyotomy (G-POEM) using a submucosal tunnel technique (video). Surg Endosc. 2014; 29(8):2377-84. DOI: 10.1007/s00464-014-3948-1. View

10.

Camilleri M . Functional Dyspepsia and Gastroparesis. Dig Dis. 2016; 34(5):491-9. DOI: 10.1159/000445226. View

11.

Toro J, Lytle N, Patel A, Scott Davis Jr S, Christie J, Waring J . Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg. 2014; 218(4):652-60. DOI: 10.1016/j.jamcollsurg.2013.12.024. View

12.

Hibbard M, Dunst C, Swanstrom L . Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011; 15(9):1513-9. DOI: 10.1007/s11605-011-1607-6. View

13.

Yang C, Wang B, Chou K, Yen H, Chen Y . Acute gastric mucosal ischemic ulcer: a rare adverse result of peroral endoscopic myotomy. Endoscopy. 2015; 47 Suppl 1:E614-5. DOI: 10.1055/s-0035-1569655. View

14.

Bapaye A, Dubale N, Pujari R, Kulkarni A, Jajoo Naval R, Vyas V . Peroral endoscopic pyloromyotomy for delayed postoperative gastroparesis. Endoscopy. 2015; 47(S 01):E581-E582. DOI: 10.1055/s-0034-1393368. View

15.

Louazon T, Rivory J, Roman S, Mion F, Ponchon T, Pioche M . Temporary dumping syndrome after gastric peroral endoscopic myotomy: should we control the glycemia?. Endoscopy. 2016; 48 Suppl 1 UCTN:E10-1. DOI: 10.1055/s-0041-111027. View

16.

Camilleri M, Parkman H, Shafi M, Abell T, Gerson L . Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2012; 108(1):18-37. PMC: 3722580. DOI: 10.1038/ajg.2012.373. View

17.

Khashab M, Stein E, Clarke J, Saxena P, Kumbhari V, Roland B . Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013; 78(5):764-8. DOI: 10.1016/j.gie.2013.07.019. View

18.

Chung H, Dallemagne B, Perretta S, Lee S, Shin S, Park J . Endoscopic pyloromyotomy for postesophagectomy gastric outlet obstruction. Endoscopy. 2014; 46 Suppl 1 UCTN:E345-6. DOI: 10.1055/s-0034-1377599. View

19.

Khashab M, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias P, Serouya S . Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2016; 85(1):123-128. DOI: 10.1016/j.gie.2016.06.048. View

20.

Jones M, Maganti K . A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003; 98(10):2122-9. DOI: 10.1111/j.1572-0241.2003.07721.x. View