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Per Oral Endoscopic Pyloromyotomy (POP) for Refractory Gastroparesis: Initial Results from a Single Institution

Ivy N Haskins, MD1, Andrew T Strong, MD1, Ryan L Plescia, PAC1, Michael S Cline, DO2, Jeffrey L Ponsky, MD, FACS1, Matthew D Kroh, MD, FACS1, John H Rodriguez, MD, FACS1. 1Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 2Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation

Introduction: Gastroparesis is a debilitating disease characterized by delayed gastric emptying in the absence of mechanical obstruction. A new intramural technique, per oral endoscopic pyloromyotomy (POP), has been proposed as an alternative to surgical pyloroplasty for the management of medical refractory gastroparesis. Herein, we detail the short-term results of POP at our institution.

Methods: POP is performed with a standard upper endoscope. A mucosotomy is made approximately five centimeters proximal to the pylorus along the lesser curvature. A submucosal tunnel is developed through the proximal dudodenum with identification of the pyloric channel. Using an electrosurgical knife, the circular muscle fibers of the pylorus are divided longitudinally after which the mucosotomy is closed with endoscopic clips. POP was first performed at our institution in January 2016. All patients undergoing POP for management of gastroparesis from January 2016 through July 2016 were prospectively followed. All patients underwent a four-hour, non-extrapolated gastric emptying study and were asked to rate their symptoms using the Gastroparesis Cardinal Symptom Index (GCSI) at their pre-procedure visit and at three months post-procedure.

Results: A total of 20 patients underwent POP during the defined study period. Fourteen (70.0%) patients had idiopathic gastroparesis, four (20.0%) had diabetic gastroparesis, and two (10.0%) had post-surgical gastroparesis. Eighteen (90.0%) patients had at least one previous intervention (i.e. enteral feeding tube, gastric pacer, botox injection) for their gastroparesis symptoms. All patients had evidence of gastroparesis on pre-procedure gastric emptying studies. There were no peri-procedural complications and all patients were discharged to home on post-procedure day number one. The average pre-procedure GCSI score was 3.8 compared to an average post-procedure GCSI of 2.8. Review of the individual components of the GCSI revealed that the greatest mean improvement in symptoms occurred in the ability of patients to finish a full-sized meal (3.7 to 2.6), improvement in appetite (3.4 to 2.4), and resolution of nausea (4.1 to 3.1).

Conclusions: POP is a safe and feasible endoscopic intervention for medical refractory gastroparesis. Additional follow-up is required to determine the long-term success of this approach in alleviating gastroparesis symptoms.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79580

Program Number: S077

Presentation Session: Flexible / Therapeutic Endoscopy and NOTES

Presentation Type: Podium

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