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Author Notes:

Corresponding author. Qiang Cai, Division of Digestive Diseases, Emory University School of Medicine, Emory Clinic ‘B’, 1365 Clifton Rd, 1st Floor, Atlanta, GA 30322, USA. Tel: +1–404–778–3184; Email: qcai@emory.edu.

An abstract of this study was presented at the proceedings of the 2016 American College of Gastroenterology conference in Las Vegas, NV, and received a Presidential Poster Award.

Conflict of interest statement: none declared.



  • G-POEM
  • fluoroscopy
  • gastric electrical stimulator
  • gastroparesis
  • pyloromyotomy

Fluoroscopic gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with a failed gastric electrical stimulator


Journal Title:

Gastroenterology Report


Volume 6, Number 2


, Pages 122-126

Type of Work:

Article | Final Publisher PDF


Background: Gastric electrical stimulators (GESs) have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications, control of psychological stressors and pharmacologic treatment. More recently, gastric peroral endoscopic pyloromyotomy (G-POEM) has emerged as a novel endoscopic technique to treat refractory gastroparesis. We present a case series of patients with refractory gastroparesis who failed treatment with an implanted GES that were safely treated with G-POEM performed under fluoroscopy as a salvage therapy. Methods: Cases of G-POEM performed on patients with refractory gastroparesis who failed treatment with a GES were retrospectively reviewed. All G-POEM procedures were performed under fluoroscopic guidance with the GES still in place. Gastroparesis Cardinal Symptoms Index (GCSI) and gastric emptying scintigraphy were assessed before and after the procedure. Patients were followed up for up to 18 months post procedure. Results: Five patients underwent G-POEM after failing treatment with a GES. Under fluoroscopy, the GES and their leads were visualized in different parts of the stomach. One GES lead was observed at the antrum near the myotomy site. All procedures were successfully completed without complications. Patients' GCSI decreased by an average of 62% 1 month post procedure. Patients also had notable improvements in gastric emptying 2 months post procedure. Conclusion: In patients with refractory gastroparesis who have failed treatment with a GES, G-POEM can be safe and effective without removing the GES. To visualize the GES and avoid cutting GES leads during myotomy, the procedure should be performed under fluoroscopy.

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© The Author(s) 2017.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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