title: Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video).
abstract: OBJECTIVE
  Gastroparesis is a chronic, debilitating condition. We report an experience conducting gastric per-oral endoscopic pyloromyotomy (G-POEM) with objectives to assess clinical efficacy, gastric emptying evolution, and procedural adverse events.
  
  
  METHODS
  This was a clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015. Patients included had severe disease as defined by elevated Gastroparesis Cardinal Symptoms Index (GCSI) score and delayed gastric emptying scintigraphy (GES). G-POEM was performed by mucosal incision upstream the pylorus followed by submucosal tunnel and antropyloromyotomy with subsequent access closure. Efficacy was assessed at 5 days, 1 month, and 3 months, based on GCSI score, and individualizing (Likert scale) the main symptoms (nausea, vomiting, abdominal pain, early satiety, and anorexia). GES was performed 2 months after the procedure.
  
  
  RESULTS
  G-POEM was successfully performed in all 12 patients, yielding a technical success rate of 100%. Significant improvements in GCSI were observed: 3.5 ± .8 versus .9 ± .9 (1 month) and 1.1 ± 1.5 (3 months), respectively (P < .001), as well as the severity of main symptoms at 3 months. Clinical efficacy was 85% (10/12). GES normalized in 75% of cases, with improvement of half emptying time (222 ± 90 minutes vs 133 ± 90 minutes; P = .03) and retention at 2 hours (76% ± 20% vs 44% ± 26%; P = .009). There were no adverse events related to the procedure.
  
  
  CONCLUSIONS
  We report a single-center study evaluating G-POEM for refractory gastroparesis, demonstrating its feasibility, reproducibility, and safety with promising clinical and scintigraphic efficacy.
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Lestelle
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Benezech
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Jonah
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France; Aix-Marseille Université, Interface de recherche translationnelle en neurogastroentérologie, CRN2M, UMR 7286, Marseille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Vitton
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.affiliation: Aix-Marseille Université, AP-HM, Service de Gastro-entérologie, Hôpital Nord, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D018589:Gastroparesis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010865:Pilot Projects; D011708:Pylorus / Q000601:surgery*; D011877:Radionuclide Imaging; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D063189:Symptom Assessment; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D055815:Young Adult