Christopher DuCoin, MD, MPH, Peter Lundberg, MD, Dietric Hennings, MD, James Korndorffer, MD, FACS. Tulane University
Background: We sought to examine the safety, efficacy, and feasibility of gastric endoscopic pyloric myotomy (G-POEM) versus laparoscopic pyloric myotomy (LPM) for the treatment of gastric outlet obstruction secondary to vagal nerve injury. We also compared G-POEM to peroral endoscopic myotomy (POEM) for feasibility. As endoscopic surgery advances, the natural progression from POEM to G-POEM seems logical. G-POEM’s utility would lend toward the treatment of gastric outlet obstruction (GOO). When caused by vagal nerve injury (VIN), aperistalsis of the gastric body occurs with a tonically contracted pyloris, resulting in symptoms such early satiety, nausea and vomiting.
Methods: With institutional review board approval a retrospective review of all G-POEM, POEM and LPM procedures performed between September 2015 and September 2016 were analyzed. G-POEM and LPM were performed only for GOO related to vagal nerve injury. Cases were reviewed for length of procedure, length of hospital stay, 30-day morbidity, and resolution of pre-operative symptoms; classified as complete, partial or nonresponsive. Endoscopic instrument passes were recorded for G-POEM and POEM to assess for complexity. A case complexity survey was provided to the surgeon after each case. Data was calculated for mean and range.
Results: Two G-POEMs and 1 LPM were performed over this time interval. There was no significant difference in age, BMI, or comorbidities. There was no difference in length of stay between the two groups (G-POEM 1.2 vs LPM 1.5 days). There were no reported 30-day morbid events and no intraoperative complications. One G-POEM had complete resolution of symptoms, one G-POEM had partial resolution of symptoms, and the LPM experienced partial resolution of symptoms. Procedure length was greater in the G-POEM (116 and 134 minutes) compared to the LPM (47 minutes). There were 38 and 42 instrument passes for the G-POEM compared to the average of 19 (12-24 passes) for POEM. The case complexity survey had an average score of 9.6 (extremely complex category), while LPM had a score of 4.2 (below average complexity).
Conclusion: G-POEM is as safe and efficacious as LPM when compared for the treatment of gastric outlet obstruction secondary to VIN. However, the feasibility of this procedure should be further studied as G-POEM was found to have a longer operative time, greater instrument passes and had a case complexity score of extremely complex. G-POEM is thus as safe and efficacious as LPM, however this is an extremely complex endoscopic procedure and should be approached with caution.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79675
Program Number: P348
Presentation Session: Poster (Non CME)
Presentation Type: Poster