PS01.044: PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS: MID—TERM SINGLE CENTRE EXPERIENCE

Abstract

Abstract Background Gastroparesis is a chronic, debilitating motility disorder. Effective treatment is challenging especially in patients with severe symptoms. G-POEM is an emerging modality for refractory gastroparesis with promising preliminary results. The aim of this prospective case series was to assess the first single-center experience with G-POEM. Main outcomes were: the clinical efficacy defined by an improvement of GCSI ≥ 40% from baseline; gastric emptying study (GES) and safety. Methods Since Nov 2015, a total of 8 patients have undergone G-POEM. The etiology of gastroparesis was post-operative in 5, diabetic in 2 and idiopathic in 1 patient. One patient underwent G-POEM for gastroparesis following a multivisceral transplantation; one underwent G-POEM and POEM as a single procedure for coexisting refractory idiopathic gastroparesis and achalasia. All patients had abnormal GES. F-u visit at 3, 6, 12 and 24M were completed in 7/8 (87.5%), 7/8 (87.5%), 5/8 (62.5%) and 1/8 (12.5%) of patients, respectively. Upper GI endoscopy and GES were performed 3M after G-POEM. Results G-POEM was successfully performed in all patients. Mean procedure time was 75 minutes (range 43–106). After G-POEM, in 7 patients mean GCSI decreased from 3.26 ± 0.96 to 0.79 ± 0.76 (at 3M; P = 0.018), 0,72 ± 0.69 (6M; P = 0.018) and 1.24 ± 0.85 (12M; P = 0.028). One women finished the 24M follow maintaining excellent outcome (mean GCSI 0.77). Treatment success was reached in 6/7 (85%) of patient at 3 and 6 months. GES normalized in all patients, mean T1/2 of GES decreased from 108 ± 30 to 62 ± 23min (P = 0.018); mean residual % at 4h decreased from 17 ± 9.2% to 2.0 ± 2.0% (P = 0.018). One patient developed bleeding ulcer 10 days after G-POEM, which was successfully managed endoscopically (clips) and by a parenteral proton pump inhibitor. Conclusion We report our first experiences with G-POEM for refractory gastroparesis, demonstrating its feasibility and safety with promising mid-term efficacy. A clinical effectiveness of G-POEM needs to be assessed in a large clinical trial. Disclosure All authors have declared no conflicts of interest.