Back to 2017 Posters

Objective: Gastroparesis affects 4 % of the population, with significant consequences to quality of life. Standard surgical management for refractory gastroparesis has been Heineke-Miculicz pyloroplasty, which carries risk of postoperative leak and/or narrowing of the gastric outlet. It also requires general anesthesia and overnight hospital stay. The introduction of an incisionless, endoscopic pyloromyotomy could revolutionize surgical management of refractory gastroparesis.
Design: Technical video, case report.
Setting: Academic, tertiary hospital.
Patient: Sixty-three-year-old male with diabetes with medically-refractory gastroparesis and daily vomiting for one year.
Intervention: Gastric per-oral endoscopic pyloromyotomy (G-POEM).
Outcome Measures: Improvement of food intolerance, resolution of daily emesis.
Results: Esophagogastroduodenoscopy was performed using a beveled endoscopic cap. A mucosal bleb was raised anteriorly, 5 cm proximal to the pylorus using an Erbe HybridKnife®, then opened. Methylene blue-dyed saline was injected to distend the submucosa. Using the HybridKnife®, a submucosal tunnel was created to the duodenal aspect of the pylorus. Myotomy was initiated distal to the mucosotomy, and continued until the pylorus was reached.
Endoscopy of true lumen revealed a widely patent pylorus, with visual evidence of submucosal dye in the duodenum. Five Hemoclips were used to close the mucosotomy.
The patient tolerated the procedure well. At 1 month, he was symptom-free and able to consume all foods without emesis.
Conclusion: We demonstrated that G-POEM is technically safe and feasible, with excellent outcome in our first patient. To our knowledge, this technique has only been performed at 2 other centers in the U.S, making our case the first in New England.