Gastric Peroral Endoscopic Myotomy Research Articles

S1089 Minimal Clinically Important Differences in Overall and Individual Gastroparesis Symptoms After G-POEM: Impact of Clinical Factors and Prior Treatments

Introduction: Gastric peroral endoscopic myotomy (G-POEM) reduces symptoms in gastroparesis to varying degrees. Studies using Gastroparesis Cardinal Symptom Index (GCSI) surveys set cutoffs for minimal clinically important differences (MCID) that reflect significant longitudinal improvement over time. Few studies have assessed MCIDs of individual gastroparesis symptoms after G-POEM or impact of clinical factors on MCID responses. We compared MCIDs to G-POEM for overall and individual symptoms relating to gastric emptying, pain and opioid use, conditions associated with gastroparesis, and prior therapy. Methods: 22 refractory gastroparesis patients completed GCSI surveys (0=no symptoms, 5=very severe) before and 85±64 days after G-POEM from 2017-21. MCIDs >1 after G-POEM were deemed significant for overall GCSI and individual nausea/vomiting (NV), early satiety/fullness (ES), and bloating/distention (BL) scores. Results: 11/22 patients (50%) met MCID cutoffs for significant GCSI decrease after G-POEM. Individual symptom decreases meeting MCID cutoffs were seen in 12 patients for NV and ES (54%) and 9 for BL (41%). NV and ES reductions were greater in those meeting GCSI MCID cutoffs; BL reductions trended higher (Figure). Gastric emptying normalized in 8/20 patients (40%) which was not different in MCID responders vs. nonresponders for GCSI (44 vs. 36%, P=1.0), NV (30 vs. 50%, P=0.65), ES (40 vs. 40%, P=1.0), or BL (56 vs. 27%, P=0.46). Pain as a major symptom was noted by 2/10 responders (20%) vs. 4/11 nonresponders (36%)(P=0.64). Opioids were used by 3/11 responders and 3/11 nonresponders (27%, P=1.0). Higher basal symptoms, associated IBS and fibromyalgia, and therapies (opioids, metoclopramide, botulinum toxin) impacted responses (Table). Conclusion: Important overall symptom responses to G-POEM using MCIDs were reported by half of gastroparesis patients. Individual symptoms of nausea/vomiting and early satiety showed meaningful decreases more often than bloating. MCID responses did not relate to gastric emptying or pain as a major symptom, but opioid use weakly predicted reduced early satiety/fullness. Increased basal gastroparesis symptoms and IBS related to greater response; fibromyalgia weakly predicted lower response. Metoclopramide use predicted response while higher numbers of botulinum toxin injections weakly related to lesser response raising concerns about pyloric scarring. These findings may be considered in selecting patients for G-POEM.Figure 1.: Individual symptom reductions in nausea/vomiting and early satiety/fullness in patients showing MCID responses in overall GCSI to G-POEM were greater than nonresponders. Bloating/distention improvements trended greater. Table 1. - Symptom Score Measuring MCID Response Associated with Improved Response Associated with Poorer Response Factor P Value Factor P Value Overall GCSI score Higher basal individual postprandial fullness score 0.04 Higher number of botulinum toxin injections 0.08 Prior metoclopramide use 0.08 Nausea/vomiting GCSI subscore Higher basal NV GCSI subscore 0.03 Diabetic gastroparesis etiology 0.09 Higher basal individual nausea score 0.02 Fibromyalgia 0.09 Higher basal individual vomiting score 0.03 Early satiety/fullness GCSI subscore Higher basal NV GCSI subscore 0.03 Fibromyalgia 0.06 Higher basal ES GCSI subscore 0.01 Higher basal individual postprandial fullness score 0.001 Prior opioid use 0.06 Prior metoclopramide use 0.01 Bloating/distention GCSI subscore IBS 0.04

Gastric peroral endoscopic myotomy for the resection of a predominantly extraluminal submucosal tumor in the duodenal bulb.

Gastric peroral endoscopic myotomy for the resection of a predominantly extraluminal submucosal tumor in the duodenal bulb.

G-POEM for severe and refractory gastroparesis

Gastroparesis is characterized by nausea, vomiting, abdominal pain and delayed gastric emptying. This chronic condition has few effective medical options. Gastric peroral endoscopic myotomy (G-POEM) is an emerging alternative to surgical pyloroplasty or pyloromyotomy that may provide relief in carefully selected patients with severe symptoms. This article summarizes the @GIJournal Twitter discussion of Martinek et al, “Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial,” originally published in Gut. In this study of 40 patients, G-POEM was associated with significant improvement in symptoms and quality of life at 6 months, including patients who crossed over from sham, and especially in those with diabetic gastroparesis. Future studies will provide data on longer follow-up periods and examine strategies for G-POEM candidate selection.

Comprehensive characterization of antral and pyloric contractions by high resolution manometry: applied physiology in suspected gastroparesis.

Delayed gastric emptying may result from diverse pathophysiological mechanisms including antral hypomotility and pylorospasm. With increasing use of gastric peroral endoscopic myotomy and preliminary evidence of efficacy, our aim was to assess the motor functions of the distal antrum and pylorus in patients with symptoms of gastroparesis using high-resolution antropyloroduodenal manometry (HR-ADM). Sixteen patients with symptoms suggestive of gastroparesis underwent HR-ADM with 13 sensors, 1 cm apart, placed across the antropyloroduodenal (APD) junction and 2 sensors, 10 cm apart, in descending and distal duodenum. The 1-h postprandial motility was quantitated as contraction frequency/minute, average amplitude, and motility index (MI). Six healthy volunteers served as controls. In the patient group, the HR-ADM identified postprandial antral hypomotility, isolated pyloric pressure waves, and tonic elevation of baseline pressure in pylorus. Patients had significantly reduced frequency of the full-hour postprandial antral contractions/minute compared with healthy volunteers [1.52 (0.97, 1.67) vs. 2.04 (1.70, 2.67), P = 0.005], as well as reduced MI [9.65 (8.29, 10.31) vs. 11.04 (10.65, 11.63), P = 0.002]. The average contraction amplitude was numerically, but not significantly reduced [51.9 (21.9, 74.9) vs. 73.0 (59.8, 82.7), P = 0.14]. Bland-Altman plots showed similar distribution of antral contraction frequency and MI during the first and second postprandial 30-min periods for both patients and controls. High-resolution ADM can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions. This technique shows promise to provide guidance for the selection of optimal treatment of patients with gastroparesis.NEW & NOTEWORTHY Current selection of different treatments for patients with gastroparesis is empiric or based on trial and error, though pyloric distensibility and diameter may predict response to pyloric interventions. High-resolution antropyloroduodenal manometry (HR-ADM) can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions in patients with suspected gastroparesis. HR-ADM shows promise to provide guidance for selection and individualization of treatments such as prokinetic agents or pyloric interventions for patients with gastroparesis based on documented pathophysiology.

How to reduce the ecological impact of gastric peroral endoscopic myotomy: a small effort for the environment.

How to reduce the ecological impact of gastric peroral endoscopic myotomy: a small effort for the environment.

Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience.

Background and study aims Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5–13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3–17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.

Fasting pyloric diameter and distensibility by functional endoluminal imaging probe in unsedated healthy volunteers.

Recent studies with functional endoluminal imaging probe (EndoFLIP® ) measure physiologic characteristics of the pylorus. EndoFLIP® has the potential to select optimal candidates for gastric peroral endoscopic myotomy (G-POEM). Normative values of the pylorus using EndoFLIP® have not been established. Twenty-four healthy volunteers (20-56years old; 15 females) underwent unsedated, transoral EndoFLIP® measurements of the pylorus after 8h of fasting. Measurements of diameter (DM), balloon pressure, and distensibility index (DI) of the pylorus were obtained twice over 5min at 40, 50, and 60ml balloon distensions. Pyloric DM at 40, 50, and 60ml balloon distensions were 13.0±2.5, 14.3±1.8, and 17.2±2.0mm, respectively. DM with 60ml distension was notably higher than with 40 and 50ml distensions. Pyloric DI at 40, 50, and 60ml distensions were 10.9±4.8, 11.3±5.8, and 11.1±4.3mm2 /mm Hg, respectively (p=0.86). Linear regression and Bland-Altman plots showed similar distribution of the DM and DI during the second minute compared with the full 5-min measurements at 50ml distension, as well as between two sequential measurements using 50ml distension. With 50ml balloon distension, intraindividual coefficients of variation (COVintra ) for DM and DI were 13.8% and 29.6%, respectively, and interindividual COV (COVinter ) were 12.6% and 51.3%, respectively. Similar reproducibility was obtained with 40ml balloon distension. Unsedated EndoFLIP® can be used to characterize human fasting pyloric diameter and distensibility, with best performance observed with 40ml and 50ml distensions and data collection during the second minute. Normative values reported serve as reference values for future studies.

The Efficacy of Gastric Per-oral Endoscopic Myotomy for Refractory Gastroparesis

The Efficacy of Gastric Per-oral Endoscopic Myotomy for Refractory Gastroparesis

Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection

Limited data exist concerning the long-term efficiency of gastric peroral endoscopic myotomy (G-POEM) as a treatment of refractory gastroparesis. This study evaluated the 3-year results of G-POEM in patients with refractory gastroparesis. This was a prospective multicenter study of all G-POEM operations performed in 2 expert French centers for 46 patients with refractory gastroparesis with at least 3 years of follow-up. Clinical success was 65.2% at 36 months. There was significant improvement in symptom severity. Median Gastroparesis Cardinal Symptom Index decreased from 3.33 to 1.80 (P< .0001), with improvement in all subscales. We created a predictive score concerning G-POEM success (G-POEM predictive score) to which points were assigned as follows: nausea subscale<2: predictive of success, 1 point; satiety subscale >4: predictive of success, 1 point; bloating subscale >3.5: predictive of success, 1 point; percentage of gastric retention at 4 hours on scintigraphy >50%: 1 point. A threshold of 2 was identified by receiver operating characteristic curve analysis with an area under the curve of .825 that predicted clinical success with a sensitivity of 93.3% (95% confidence interval [CI], .77-.99), specificity of 56.3% (95% CI, .33-.77), positive predictive value of 80% (95% CI, .67-.93), negative predictive value of 81.8% (95% CI, .59-1.00), and accuracy of 80.4% (95% CI, .69-.92). Patients with a score≥2 were significantly more likely to be responders at 3 years than were patients with a score<2 (80% and 18%, respectively; P= .0004). The clinical success of G-POEM for refractory gastroparesis was 65.2% at 36 months. Our predictive score offers an easy tool that needs to be confirmed in other studies.

POEM, GPOEM, and ZPOEM.

Our tripartite narrative review discusses Peroral Endoscopic Myotomy (POEM), gastric POEM (GPOEM) and POEM for Zenker's diverticula (ZPOEM). POEM is the prototypical procedure that launched the novel "3rd space endoscopy" field of advanced endoscopy. It revolutionized achalasia therapy by offering a much less invasive version of the prior gold standard, the laparoscopic Heller myotomy (HM). We review in detail indications, outcomes, technique variations and comparative data between POEM and HM particularly with regard to the hotly debated issue of GERD. We then proceed to discuss two less illustrious but nevertheless important offshoots of the iconic POEM procedure: GPOEM for gastroparesis and ZPOEM for the treatment of hypopharyngeal diverticula. For GPOEM, we discuss the rationale of pylorus-directed therapies, briefly touch on GPOEM technique variations and then focus on the importance of proper patient selection and emerging data in this area. On the third and final part of our review, we discuss ZPOEM and expound on technique variations including our "ultra-short tunnel technique". Our review emphasizes that, despite the superiority of endoscopy over surgery for the treatment of hypopharyngeal diverticula, there is no clear evidence yet of the superiority of the newfangled ZPOEM technique compared to the conventional endoscopic myotomy technique practiced for over two decades prior to the advent of ZPOEM.

Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis (with video)

Gastric peroral endoscopic myotomy (G-POEM) is used for refractory gastroparesis (RG) with good early-term but variable mid- and long-term outcomes. Limited data exist about candidates and long-term clinical and predictive factors. Our aim was to evaluate the 4-year follow-up efficacy and predictive factors in patients with RG. Confirmed RG patients were included and evaluated between April 2017 and December 2021. Gastroparesis Cardinal Symptom Index (GCSI) score, retention percentage at 4 hours (RP4H), mean half-emptying time (MHET), and the 36-item short-form survey (SF-36) were performed at 1, 6, 12, 18, 24, 30, 36, 42, and 48 months. After G-POEM, 374 patients with RG were included: 141 patients (37.7%) had diabetic gastroparesis (DG), 115 (30.7%) had idiopathic gastroparesis (IG), 102 (27.3%) had postsurgical gastroparesis (PSG), and 16 (4.3%) had other etiologies. After the 48-month evaluation, 102 patients completed follow-up (DG, 58; IG, 22; PSG, 18; other, 4). Before G-POEM, GCSI score, RP4H, and MHET were 3.84 ± .53, 44% (interquartile range [IQR], 11-68), and 246 minutes (IQR, 150-368), respectively, and after the 48-month evaluation improved to 2.1 ± .70 (P< .001), 15.5% (IQR, 0-36; P= .021), and 135 minutes (IQR, 67-290; P= .045), respectively. At the 48-month evaluation, clinical success was 77.5%. DG showed the best outcomes (DG vs IG vs PSG vs other: 86.5% vs 72.5% [P= .001] vs 72.1% [P= .003] vs 68.8% [P< .001]). Long-term success predictors were DG (odds ratio [OR], 5.113; 95% confidence interval [CI], 1.643-5.981; P= .035), early diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P= .042), nausea/vomiting (OR, 3.541; 95% CI, 1.881-5.511; P= .012), GCSI score at 6 months (1.5-2) (OR, 3.612; 95% CI, 2.122-5.317; P= .022), and RP4H<10% at 6 months (OR, 2.188; 95% CI, 1.435-4.233; P= .039). G-POEM is an effective 4-year treatment in patients with RG, especially in DG, establishing a potential first-line therapy in these patients. However, randomized controlled clinical trials are needed to confirm these results. (Clinical trial registration number: NTC03126513.).

New Applications for Submucosal Tunneling in Third Space Endoscopy: A Comprehensive Review.

Third space endoscopy (TSE), a type of natural orifice transluminal endoscopic surgery, was first introduced a decade ago, and since then, has revolutionized the field of therapeutic endoscopy. TSE involves tunneling into the submucosal space between the intestinal mucosa and the muscularis propria. By accessing this "third space," endoscopists can perform minimally invasive myotomies, resections, and dissections while maintaining the mucosa and preventing full-thickness perforation. TSE procedures can be used to treat motility disorders as well as neoplasms throughout the gastrointestinal tract, which were traditionally conditions that would require open or laparoscopic surgery. The main TSE procedures include peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy. Some of those procedures have now been accepted as viable alternative to surgical techniques due to their limited invasiveness, safety and cost. This review will explore the different techniques recently added to our arsenal while describing their potential efficacy and limitations.

Author commentary on Linda Y. Zhang et al.

Linda Y. Zhang et al. Gastric per-oral endoscopic myotomy (G-POEM) for the treatment of gastric sleeve stenosis: a feasibility and safety study

Gastric per-oral endoscopic myotomy: Indications, technique, results and comparison with surgical approach.

Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying, without the presence of a stenosis. For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis. Studies with EndoFLIP, a device that assesses pyloric distensibility, increased the knowledge about pylorospasm. Based on this data, several pyloric-targeted therapies were developed to treat refractory gastroparesis: Surgical pyloroplasty and endoscopic approach, such as pyloric injection of botulinum and pyloric stenting. Notwithstanding, the success of most of these techniques is still not complete. In 2013, the first human gastric per-oral endoscopic myotomy (GPOEM) was performed. It was inspired by the POEM technique, with a similar dissection method, that allows pyloromyotomy. Therapeutical results of GPOEM are similar to surgical approach in term of clinical success, adverse events and post-surgical pain. In the last 8 years GPOEM has gained the attention of the scientific community, as a minimally invasive technique with high rate of clinical success, quickly prevailing as a promising therapy for gastroparesis. Not surprisingly, in referral centers, its technical success rate is 100%. One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.

Systematic review with meta-analysis: one-year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis.

Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1year of follow-up. We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1year of follow-up. Our outcomes of interest were clinical success at 1year, adverse events, difference in mean pre- and 1year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre- and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I2 statistic. We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1year post-procedure was significantly lower than pre-procedure; mean difference (MD) (95% CI) -1.4 (-1.9, -0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre- and post-procedure EndoFLIP measurements. G-POEM is associated with modest clinical success at 1year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.

Endoscopic through-the-scope suturing.

Background and AimsThere is growing interest in closure of larger mucosal defects, given the increasing use of endoscopic resection for early GI neoplasia and the advent of submucosal endoscopy, including peroral endoscopic myotomy. Existing closure methods include through-the-scope clips, over-the-scope clips, and over-the-scope suturing. Although over-the-scope clips and over-the-scope suturing allow closure of large defects, both require endoscope removal for device application and may have difficulty in treating lesions in the proximal colon or the small intestine. Hence, a significant gap exists for a through-the-scope device capable of closing larger defects. The novel X-Tack system (Apollo Endosurgery, Austin, Tex, USA) offers through-the-scope suturing (TTSS), which eliminates the need to withdraw the endoscope from the patient before applying therapy.MethodsWe demonstrate the possible indications for endoscopic mucosal adhesion with TTSS through a video case series. We present 5 cases to illustrate the use of TTSS in the closure of a duodenal EMR defect, a cecal EMR defect, mucostomy after esophageal and gastric peroral endoscopic myotomy, and, finally, for primary closure of a gastrogastric fistula.ResultsAll defects were successfully closed with 1 to 2 TTSS systems. There were no postprocedure adverse events, including bleeding or perforation, at a median of 30 (range 14-30) days of follow-up.ConclusionsTTSS is a valuable addition to mucosal closure devices, which allows closure through a gastroscope or a colonoscope, without requiring endoscope removal for device application. Likely applications include larger or more distant defects and those located within tight spaces. Pending further clinical evaluation, important areas for research include assessment of the learning curve, comparative trials with other closure devices, and cost-effectiveness analysis.

Efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis: 3-year follow up results

Gastroparesis is a common but easily overlooked disease. Gastric peroral endoscopic myotomy (G-POEM) is one of the third-space endoscopy techniques to treat gastroparesis. In this study, we aimed to evaluate the efficacy and safety of G-POEM for patients with refractory gastroparesis. Between December 2017 and 2020, we consecutively enrolled patients with gastroparesis who failed after the administration of several kinds of medication and repeated admission for nutritional support. All patients underwent gastric emptying scintigraphy and answered a questionnaire on Gastroparesis Cardinal Symptom Index (GCSI). Demographic data, endoscopic procedure, and post procedural outcome were analyzed. A total of 11 (9 women and 2 men) patients with refractory gastroparesis (nine with diabetes mellitus, one systemic lupus erythematosus, and one idiopathic) were enrolled. The mean (±standard deviation (SD)) procedure time was 61.82 (±18.99) min with technical and clinical success rates of 100% and 81.82%, respectively. A statistically significant improvement was observed in the clinical severity (mean GCSI score 36.00 vs. 14.73, p<0.0001) and gastric emptying time (mean T1/2 341.92 vs. 65.92min, p=0.016) after G-POEM. Hospital stay was 7.18 (±4.49) days without mortality. Complications included 4 (36.36%) patients with self-limited postprocedural abdominal pain and 3 (27.27%) patients with intra-procedural pneumoperitoneum. During the mean follow-up period of 554.36 days, one (9.09%) patient had relapsed clinical symptoms after 6 months. G-POEM is an efficient and safe pylorus-directed endoscopic therapy for refractory gastroparesis with promising results.

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

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

S976 Gastric Peroral Endoscopic Myotomy (GPOEM) Improves Symptoms and Need for Hospital Admission for Gastroparesis and Lung Transplant Patients

S976 Gastric Peroral Endoscopic Myotomy (GPOEM) Improves Symptoms and Need for Hospital Admission for Gastroparesis and Lung Transplant Patients

S2536 Gastric Peroral Endoscopic Myotomy (G-POEM) Is a Treatment Option for Persistent Gastroparesis Following Catheter Ablation in Atrial Fibrillation

S2536 Gastric Peroral Endoscopic Myotomy (G-POEM) Is a Treatment Option for Persistent Gastroparesis Following Catheter Ablation in Atrial Fibrillation