title: Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).
abstract: OBJECTIVE
  Gastric per-oral endoscopic myotomy (G-POEM) recently has been reported as minimally invasive therapy for gastroparesis. The aims of this study were to report on the first multicenter experience with G-POEM and to assess the efficacy and safety of this novel procedure for patients with gastroparesis with symptoms refractory to medical therapy.
  
  
  METHODS
  All patients with gastroparesis who underwent endoscopic pyloromyotomy (G-POEM) at 5 medical centers were included. Procedures were performed following the same principles as esophageal POEM. Clinical response was defined as improvement in gastroparetic symptoms with absence of recurrent hospitalization. Adverse events were graded according to the American Society for Gastrointestinal Endoscopy lexicon.
  
  
  RESULTS
  A total of 30 patients with refractory gastroparesis (11 diabetic, 12 postsurgical, 7 idiopathic) underwent G-POEM. Previous therapies included Botox injection in 12, transpyloric stenting in 3, and PEG with jejunal extension (PEGJ) in 1. Nausea/vomiting were the predominant symptoms in 25 patients. Weight loss was present in 27 patients with an average of 10% loss of body weight. G-POEM was completed successfully in all 30 (100%) patients with a mean procedure time of 72 minutes (range, 35-223 min). The mean myotomy length was 2.6 ± 2.3 cm. The mean length of hospital stay was 3.3 days (range, 1-12 days). Two adverse events occurred in 2 (6.7%) patients, including 1 capnoperitoneum and 1 prepyloric ulcer, rated as mild and severe, respectively. Clinical response was observed in 26 (86%) patients during a median follow-up of 5.5 months. Four patients (2 diabetic, 1 postsurgical, 1 idiopathic cause) did not respond to G-POEM. Repeat gastric emptying scan was obtained in 17 patients, normalized in 8 (47%), and improved in 6 (35%) patients.
  
  
  CONCLUSIONS
  G-POEM is a technically feasible procedure. This small non-randomized study suggests the effectiveness of G-POEM for the treatment of patients with gastroparesis refractory to medical therapy. It concomitantly results in normalization of GES in a significant proportion of treated patients.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Carr-Locke
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Amol
authors.initials: A
authors.lastname: Bapaye
authors.affiliation: Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA.
authors.forename: Petros C
authors.initials: PC
authors.lastname: Benias
authors.affiliation: Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Serouya
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Shivangi
authors.initials: S
authors.lastname: Dorwat
authors.affiliation: Gatrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Dalton M
authors.initials: DM
authors.lastname: Chaves
authors.affiliation: Gatrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Everson
authors.initials: E
authors.lastname: Artifon
authors.affiliation: Gatrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Eduardo G
authors.initials: EG
authors.lastname: de Moura
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Majidah
authors.initials: M
authors.lastname: Bukhari
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Gulara
authors.initials: G
authors.lastname: Hajiyeva
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Ismail
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Chung
mesh_terms: D000328:Adult; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011708:Pylorus / Q000601:surgery*; D019233:Retreatment; D016896:Treatment Outcome