Technical Aspects of Peroral Endoscopic Pyloromyotomy

Jie Tao; Vaishali Patel; Parit Mekaroonkamol; Hui Luo; Baiwen Li; Qunye Guan; Shanshan Shen; Huimin Chen; Qiang Cai

doi:10.1016/j.giec.2018.08.012

Technical Aspects of Peroral Endoscopic Pyloromyotomy

Gastrointest Endosc Clin N Am. 2019 Jan;29(1):117-126. doi: 10.1016/j.giec.2018.08.012.

Authors

Jie Tao¹, Vaishali Patel², Parit Mekaroonkamol², Hui Luo³, Baiwen Li⁴, Qunye Guan⁵, Shanshan Shen⁶, Huimin Chen⁷, Qiang Cai⁸

Affiliations

¹ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 227 Yanta West Road, Xi'an 710061, China.
² Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA.
³ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Pancreatobiliary Disease, Xijing Hospital of Digestive Disease, Fourth Military Medical University, 169 Changle West Road, Xi'an 710032, China.
⁴ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, Shanghai 200080, China.
⁵ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Gastroenterology, Weihai Municipal Hospital, 70 Heping Road, Weihai 264200, China.
⁶ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
⁷ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandongzhong Road, Shanghai 200240, China.
⁸ Division of Digestive Disease, Emory University School of Medicine, 1365 Clifton RD NE, Suite B 1262, Atlanta, GA 30322, USA; Advanced Endoscopy Fellowship, Emory University School of Medicine, 1365 Clifton Road, B1262, Atlanta, GA 30322, USA. Electronic address: qcai@emory.edu.

PMID: 30396521
DOI: 10.1016/j.giec.2018.08.012

Abstract

Gastric peroral endoscopic pyloromyotomy (G-POEM or POP) is a feasible and effective procedure for the treatment of refractory gastroparesis. G-POEM is a technically demanding endoscopic procedure. As of yet, there is no consensus on the technique. A variety of techniques have been reported in published studies. The essential technical steps of the procedure are (1) establishment of submucosal tunnel in gastric antrum, (2) identification of the pyloric muscular ring, (3) selective circular myotomy, and (4) a 2.5-cm to 3.0-cm length of myotomy. There are still some technical questions unanswered, and more studies are needed to establish standardized techniques and possible improvement of outcomes.

Keywords: G-POEM; POP; Refractory gastroparesis; Technical aspects.

Publication types

Review

MeSH terms

Gastroparesis / surgery*
Gastroscopy / methods
Humans
Natural Orifice Endoscopic Surgery / methods
Pyloromyotomy / methods*
Pylorus / surgery*
Treatment Outcome