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DOI: 10.1055/s-0038-1637168
PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS – A SINGLE CENTRE EXPERIENCE
Publikationsverlauf
Publikationsdatum:
27. März 2018 (online)
Aims:
Gastroparesis is a chronic, debilitating motility disorder. Effective treatment is challenging especially in patients with severe symptoms. G-POEM is an emerging modality for refractory gastroparesis with promising preliminary results. The aim of this prospective case series was to assess our first experience with G-POEM. Main outcomes were: the efficacy defined by improvement of GCSI ≥40% from baseline; GES evolution and safety.
Methods:
Since Nov 2015, a total of 7 patients underwent G-POEM. The etiology of gastroparesis was post-operative in 4, diabetic in 2 and idiopathic in 1 patient. One patient underwent G-POEM for gastroparesis following a multivisceral transplantation; one underwent G-POEM and POEM as a single procedure for coexisting refractory idiopathic gastroparesis and achalasia. All patients had GCSI score > 2.3 and delayed GES. F-u visit at 3, 6, 12 and 24 M were completed in 7/7 (100%), 7/7 (71%), 4/7 (57%) and 1/7 (14%) of patients, respectively. Endoscopy and GES were performed 3 M after G-POEM.
Results:
G-POEM was successfully performed in all patients. Mean procedure time was 70 minutes (range 63 – 106). After G-POEM, mean GCSI decreased from 3.26 ± 0.96 to 0.79 ± 0.76 (at 3 M), 0,72 ± 0.69 (6 M) and 0.86 ± 0.28 (12 M). One women finished the 24 M follow maintaining excellent outcome (mean GCSI 0.77). Treatment success was reached in 6/7 (85%) of patient. GES normalized in all patients, mean T1/2 of GES decreased from 108 ± 30 to 62 ± 23 min; mean residual % at 4h decreased from 17 ± 9.2% to 2.0 ± 2.0%. One patient developed bleeding ulcer 10 days after G-POEM, this adverse event was successfully managed endoscopically (clips) and by parenteral PPI.
Conclusions:
We report our first experiences with G-POEM for refractory gastroparesis, demonstrating its feasibility and safety with promising clinical efficacy. A clinical effectiveness of G-POEM needs to be assessed in a large clinical trial.