S3377 Myotomy Site Steroid Injection During Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis

Abstract

Introduction: Gastric Peroral Endoscopic Myotomy (GPOEM) has emerged as a therapeutic modality for refractory Gastroparesis. Steroid injection has been used to halt post-intervention fibrosis following esophageal dilation. We aimed to evaluate the safety and efficacy of steroid injection at the myotomy site during GPOEM. Methods: Retrospective chart review of all patients undergoing GPOEM from 7/11/2020 to 1/30/2021 at a single tertiary care academic center. Pre-procedure gastroparesis cardinal symptom index (GCSI) was obtained for all patients. After myotomy, a total of 4 cc of Triamcinolone were injected in a 4-quadrant fashion at the margins of the myotomy and otherwise, GPOEM performed in the standard fashion. Clinical success was defined as a decrease of at least 1 point in mean GCSI and a 25% decrease in at least two subsets of cardinal symptoms. If post-procedure GCSI was not available, patient-reported symptoms were used to indicate clinical success during the 1-6 months clinic follow-up. Results: A total of 20 patients (Age 47.8±12, 60 % female) were included. The etiology of gastroparesis included Idiopathic n = 9, Diabetic n = 7, and post-surgical n = 4. Pre-procedure GCSI= 3.7 ± 1. All patients underwent myotomy site triamcinolone injection. Four patients were lost to follow-up. Out of the 16 patients with follow-up, the post-procedure GCSI score was available for six patients. Clinical success was achieved in 69% (n = 11/16). There were no infectious complications. One patient presented with melena 3 days post-procedure and bleeding was self-limited. Conclusion: Steroid injection at the myotomy site is safe and results in comparable short-term efficacy compared to reported success rates. Prospective trials with long-term follow up is required for further evaluation of the long-term effect of steroid injection