G-POEM Gastric Peroral Endoscopic Myotomy

Dr. Khashab and his colleagues pioneered the G-POEM at John’s Hopkins. The POEM was initially performed on patients suffering from Achalasia and provided encouraging results.  The POEM was then trialed on individuals with Gastroparesis.  Instead of opening the sphincter between the esophagus and stomach, the surgeon will open the pyloric valve. Through endoscopic measures, the inner layer of the pyloric valve is cut, also known as a myotomy.  

Preparation: 

You will be on a liquid diet for 48 hours prior to the procedure. This is to ensure that nothing is in the stomach or esophagus the day of the procedure. Twelve hours before the G-POEM you will be asked to take nothing by mouth.

Before the procedure: 

You will be asked to report 2 hours before the procedure.
An IV will be inserted to provide fluids, anesthesia, and antibiotics.

During the procedure: 

You will be asleep.
An arterial line will be placed to monitor your blood pressure.
The doctor will insert an endoscope and inspect the pyloric valve.
After the inspection, an incision in the stomach will be made.  The doctor will then cut the inner lining of the pyloric valve. This is termed myotomy.
After this, the incision will be closed with standard endoscopic clips.

After the procedure: 

You will be taken to recovery as the IV sedation wears off.  
Once recovered, you will be admitted for observation.
You still will not be able to eat or drink.
The next morning you will have an upper GI with barium.
If there appears to be no complications, you will be discharged and able to go home.
Although there are no long-term results, as this procedure is fairly new, the short-term results are very exciting and hopeful.  Literature supports that G-POEM improves both symptoms and gastric emptying in postinfectious, postsurgical, and idiopathic refractory gastroparesis (Mekaroonkamol et al., 2016).


References
Johns Hopkins Medicine (n.d). Gastroenterology and hepatology: Peroral endoscopic myotomy (POEM). Retrieved from here.

Mekaroonkamol, P., Dacha, S., Keilin, S. D., Willingham, F. F., Cai, Q., Li, L. Y., & Xu, Y. (2016). Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes. Neurogastroenterology and Motility, 28(8), 1272-1277.