Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video)

Published:December 25, 2020DOI:

      Background and Aims

      Gastroparesis (GP) is a multifactorial disease associated with a large burden on the health care systems. Pyloric-directed therapies including gastric peroral endoscopic myotomy (G-POEM) can be effective in improving patient quality of life and symptom severity. We report on the safety and efficacy of G-POEM and its impact on the quality of life of patients managed at a large referral center.


      Consecutive patients with confirmed GP referred for G-POEM due to failure of medical therapy were included. All patients were assessed at baseline and then at 1, 3, 6, and 12 and 24 months after G-POEM using validated symptom and quality of life instruments, including the Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and 36-Item Short Form Survey (SF-36). Patients were evaluated before and 6 months after the procedure with EGD, 4-hour scintigraphy, and pyloric EndoFLIP. Technical success was defined as the ability to perform full-thickness pyloromyotomy. Clinical response was defined as an improvement of ≥1 point on GCSI.


      Fifty-two patients (median age, 48 years; range, 25-80 years, 88% female) underwent G-POEM between February 2018 and September 2020 for the following phenotypes: vomiting-predominant (n=30), dyspepsia-predominant (n=16), and regurgitation-predominant (n=6) GP. The technical success rate was 100%. Adverse events were noted in 3 of 52 patients (5.77%), and were all managed successfully endoscopically. Clinical response was achieved in 68%, 58%, and 48% of patients at 1-month, 6-month, and 12-month follow-up (P < .001, P < .001, and P < .01, respectively). When classified by the cause of GP, the clinical response rates were diabetic GP 64% (11 of 17), postsurgical GP 67% (6 of 9), and idiopathic GP 72% (13 of 18). A statistically significant improvement in PAGI-SYM scores was observed at 1, 3, 6, 12, and 24 months, in addition to significant improvement in several domains of SF-36. Mean 4-hour gastric emptying was reduced 6 months after G-POEM (10.2%) compared with baseline (36.5%, P < .001). We report a significant reduction in the number of emergency department visits and days spent in the hospital up to 24 months after G-POEM.


      G-POEM appears to be a safe and feasible treatment alternative for refractory GP with significant short-term and mid-term improvements in overall symptoms, quality of life scores, and health care utilization.

      Graphical abstract


      BL (bloating), GCSI (Gastroparesis Cardinal Symptom Index), GES (gastric emptying scan), FLIP (functional luminal imaging probe), GP (gastroparesis), G-POEM (gastric peroral endoscopic myotomy), HR (heartburn/regurgitation), LA (lower abdominal), NV (nausea and vomiting), PAGI-SYM (Patient Assessment of Gastrointestinal Disorders Symptom Severity Index), PDI (Pyloric Distensibility Index), PS (postprandial fullness/early satiety), QOL (quality of life), SF-36 (36-Item Short Form Survey), UA (upper abdominal pain)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Camilleri M.
        • Parkman H.P.
        • Shafi M.A.
        • et al.
        Clinical guideline: management of gastroparesis.
        Am J Gastroenterol. 2013; 108 (quiz 8): 18-37
        • Mearin F.
        • Camilleri M.
        • Malagelada J.R.
        Pyloric dysfunction in diabetics with recurrent nausea and vomiting.
        Gastroenterology. 1986; 90: 1919-1925
        • Arts J.
        • Holvoet L.
        • Caenepeel P.
        • et al.
        Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis.
        Aliment Pharmacol Ther. 2007; 26: 1251-1258
        • Khashab M.A.
        • Besharati S.
        • Ngamruengphong S.
        • et al.
        Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video).
        Gastrointest Endosc. 2015; 82: 1106-1109
        • Khashab M.A.
        • Ngamruengphong S.
        • Carr-Locke D.
        • et al.
        Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).
        Gastrointest Endosc. 2017; 85: 123-128
        • Rodriguez J.
        • Strong A.T.
        • Haskins I.N.
        • et al.
        Per-oral pyloromyotomy (POP) for medically refractory gastroparesis: short term results from the first 100 patients at a high volume center.
        Ann Surg. 2018; 268: 421-430
        • Jagtap N.
        • Kalapala R.
        • Reddy D.N.
        Assessment of pyloric sphincter physiology using functional luminal imaging probe in healthy volunteers.
        J Neurogastroenterol Motil. 2020; 26: 391-396
        • Watts L.S.
        • Baker J.R.
        • Lee A.A.
        • et al.
        Impact of gastric per-oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients.
        Neurogastroenterol Motil. 2020; 32: e13892
        • Vosoughi K.
        • Ichkhanian Y.
        • Jacques J.
        • et al.
        Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video).
        Gastrointest Endosc. 2020; 91: 1289-1299
      1. Li P, Ma B, Gong S, et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: a meta-analysis. J Gastrointest Surg. Epub 2020 May 11.

        • Uemura K.L.
        • Chaves D.
        • Bernardo W.M.
        • et al.
        Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis.
        Endosc Int Open. 2020; 8: E911-E923
        • Parkman H.P.
        • Yates K.
        • Hasler W.L.
        • et al.
        Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity.
        Gastroenterology. 2011; 140: 101-115
        • Janssen P.
        • Harris M.S.
        • Jones M.
        • et al.
        The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis.
        Am J Gastroenterol. 2013; 108: 1382-1391
      2. Abdelfatah MM, Noll A, Kapil N, et al. Long-term outcome of gastric per-oral endoscopic pyloromyotomy in treatment of gastroparesis. Clin Gastroenterol Hepatol. Epub 2020 May 22.

        • Tyberg A.
        • Seewald S.
        • Sharaiha R.Z.
        • et al.
        A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.
        Gastrointest Endosc. 2017; 85: 1208-1211
        • Koul A.
        • Dacha S.
        • Mekaroonkamol P.
        • et al.
        Fluoroscopic gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with a failed gastric electrical stimulator.
        Gastroenterol Rep (Oxf). 2018; 6: 122-126
      3. Ragi O, Jacques J, Branche J, et al. One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study. Endoscopy. Epub 2020 Jun 23.

        • Dacha S.
        • Mekaroonkamol P.
        • Li L.
        • et al.
        Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video).
        Gastrointest Endosc. 2017; 86: 282-289

      Linked Article

      • Gastric POEM for gastroparesis: Panacea, placebo, or pathway to the future?
        Gastrointestinal EndoscopyVol. 94Issue 1
        • Preview
          Gastroparesis (GP) is a syndrome defined by delayed gastric emptying in the absence of mechanical obstruction.1 Typical symptoms include abdominal pain, nausea, vomiting, early satiety, bloating, and/or weight loss.2 It is 1 of the 2 most common sensorimotor disorders of the stomach, the other being functional dyspepsia.3 It is estimated that approximately 5 million adults in the United States have GP symptoms.4 The causes of GP are diverse; there are more than 50 recognized causes, although diabetes accounts for the majority of known cases (25%).
        • Full-Text
        • PDF