Successful repeated gastric peroral endoscopic myotomy (re-G-POEM) in the treatment of postsurgical gastroparesis
Authors:
D. Dražilová 1; Z. Vacková 1; R. Husťak 1; M. Buncová 2; J. Martínek 1
Authors‘ workplace:
Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
1; Pracoviště nukleární medicíny, Institut klinické a experimentální medicíny, Praha
2
Published in:
Rozhl. Chir., 2022, roč. 101, č. 1, s. 37-41.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.1.37–41
Overview
Introduction: Gastric peroral endoscopic myotomy (G-POEM) is a promising but still experimental endoscopic method for the treatment of gastroparesis.
Case report: We describe the case of a 31 years old female patient with severe refractory postsurgical gastroparesis preceded by fundoplication done for reflux disease. She has had digestive problems since childhood. In 2018, the first G-POEM was performed but did not lead to any clinical improvement. We proposed to perform a repeated G-POEM given that impedance planimetry measurement showed persistent pylorospasm. The patient agreed and the second G-POEM was performed in February 2021 (the first re-G-POEM in the Czech Republic) with a satisfactory clinical result; a subsequent gastric emptying study also showed a significant improvement.
Conclusion: This case report shows the feasibility of performing a repeated endoscopic pyloromyotomy in patients with gastroparesis and proven pylorospasm. One can only hypothesize whether the lack of effect of the first procedure was caused by an incomplete myotomy (failure of the procedure) or the need for a double myotomy, which is considered a standard in some centers.
Keywords:
case report − postsurgical refractory gastroparesis − re-G-POEM
Sources
1. Weusten BLAM, Barret M, Bredenoord AJ, et al. Endoscopic management of gastrointestinal motility disorders - part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020 Jun;52(6):498−515. doi: 10.1055/a- 1160-5549.
2. Arts J, Holvoet L, Caenepeel P, et al. Clinical trial: A randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251−1258. doi: 10.1111/j.1365-2036.2007.03467.x.
3. Bae JS, Kim SH, Shin CI, et al. Efficacy of gastric balloon dilatation and/or retrievable stent insertion for pyloric spasms after pylorus-preserving gastrectomy: Retrospective analysis. PLoS One. 2015 Dec 10;10(12):e0144470. doi:10.1371/journal. pone.0144470.
4. Mancini SA, Angelo JL, Peckler Z, et al. Pyloroplasty for refractory gastroparesis. Am Surg. 2015 Jul;81(7):738−746. PMID: 26140897.
5. Jacques J, Pagnon L, Hure F, et al. Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy 2019;51:40–49. doi: 10.1055/a-0628-6639.
6. Malik Z, Sankineni A, Parkman HP. Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis. Neurogastroenterol Motil 2015;27:524– 531. doi: 10.1111/nmo.12522.
7. Khashab MA, Stein E, Clarke JO, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013 Nov;78(5):764−768. doi: 10.1016/j. gie.2013.07.019.
8. Hustak R, Vackova Z, Krajciova J, et al. Per-oral endoscopic pyloromyotomy (g-poem) for the treatment of gastroparesis – a pilot single-centre study with mid-term follow-up. Rozhl Chir. 2020 Winter;99(3):116−123. doi: 10.33699/ PIS.2020.99.3.116-123.
9. Aghaie Meybodi M, Qumseya BJ, Shakoor D, et al. Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and meta-analysis. Endosc Int Open. 2019 Mar;7(3):E322−E329. doi: 10.1055/a- 0812-1458.
10. Mohan BP, Chandan S, Jha LK, et al. Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group. Surg Endosc. 2020 Aug;34(8):3352−3367. doi: 10.1007/ s00464-019-07135-9.
11. Spadaccini M, Maselli R, Chandrasekar VT, et al. Gastric peroral endoscopic pyloromyotomy for refractory gastroparesis: a systematic review of early outcomes with pooled analysis. Gastrointest Endosc. 2020 Apr;91(4):746−752.e5. doi: 10.1016/j.gie.2019.11.039.
12. Vosoughi K, Ichkhanian Y, Benias P, et al. Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial. Gut 2021 Mar 19:gutjnl-2020−322756. doi: 10.1136/gutjnl-2020-322756.
13. Landreneau JP, Strong AT, El-Hayek K, et al. Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. Surg Endosc. 2019 Mar;33(3):773−781. doi: 10.1007/ s00464-018-6342-6.
14. Abdelfatah MM, Li B, Kapil N, et al. Shortterm outcomes of double versus single pyloromyotomy at peroral endoscopic pyloromyotomy in the treatment of gastroparesis (with video). Gastrointest Endosc. 2020 Sep;92(3):603−609. doi: 10.1016/j.gie.2020.01.016.
15. Welinsky S, Wynter J, Jodorkovsky D, et al. Repeat gastric peri-oral endoscopic myotomy for treatment of gastroparesis: A case series. Esophagus 2: Poster 2021;93,6. doi:10.1016/j.gie.2021.03.637.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
![Issue 1](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/62ba2c1bf7812140ff8c8b5cfa4ceb3e.jpg)
2022 Issue 1
Most read in this issue
- High resolution anorectal manometry in patients with anorectal dysfunctions and the therapeutic consequences
- Incarcerated left paraduodenal hernia − case report and literature review
- Successful repeated gastric peroral endoscopic myotomy (re-G-POEM) in the treatment of postsurgical gastroparesis
- Endoscopic management of gastrointestinal motility disorders