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

• Authors: Abhinav Koul, University of California Davis; Sunil Dacha, Emory University; Parit Mekaroonkamol, Emory University; Xiaoyu Li, Qingdao University; Lianyong Li, PLA 306 Hospital; Nikrad Shahnavaz, Emory University; Steven Keilin, Emory University; Field Willingham, Emory University; Jennifer Christie, Emory University; Qiang Cai, Emory University
• Journal Title: Gastroenterology Report
• Volume: Volume 6, Number 2
• Publisher: Oxford University Press (OUP): Policy C - Option A | 2018-05, Pages 122-126
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/gastro/gox040
• Subjects: Health Sciences, General
• Keywords: G-POEM; fluoroscopy; gastric electrical stimulator; gastroparesis; pyloromyotomy

Abstract

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.