Gastroparesis is a gastric motility disorder that causes several upper gastrointestinal symptoms namely nausea, early satiety, vomiting, fullness of stomach, bloating, bloating and at times weight loss. It is a chronic debilitating condition and it is characterized by delayed gastric emptying without mechanical barrier. The pathogenesis is poorly understood. Diabetes and surgery are some of the etiologies for this condition and it is also seen in patients without any cause (idiopathic). It affects quality of life and its incidence and prevalence are increasing lately.
Diet and medicines are commonly tried but they are not helpful in alleviating the symptoms except in a small minority of patients. The medicines that are used have serious side effects (Reglan and Erythromycin). Reglan in particular has black box warning (tardive dyskinesia). Domperidone is another medication and it is not available in the US. Medicine in general has a small role and majority of the patients with this condition look forward to better treatment options. Gastric PerOral Endoscopic Myotomy (G POEM) is a non surgical treatment option which has been very effective and currently being offered in major teaching hospitals like Mayo Clinic and Johns Hopkins.
We have been very fortunate in Upstate South Carolina to offer this innovative procedure. This procedure is done under general anesthesia and using an endoscope which is passed through the mouth to the stomach. The procedure involves reaching the pyloric sphincter muscle through the wall of the stomach and the sphincter muscle is divided to help with better emptying of the stomach. Usually over night stay is all that is required for this procedure.
Studies have shown G POEM is successful in significantly reducing the symptoms of Gastroparesis in about 80% of the patients and it is durable in long term studies. The treatment being new the long term studies have been about three to four years1,2. In patients who have had gastric pacemaker and still symptomatic G POEM has shown significant improvement in at least about 60% of the patients. Surgical treatment like Gastric pacemaker and pyloroplasty are more invasive and have increased risks.
1. Long-term outcomes (> 3 years) after gastric peroral endoscopic myotomy for refractory gastroparesis: a systematic review and meta-analysis. Andrew Canakis et al
2. Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis. Oscar Victor Hernandez Mondragon et al.