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Gastric Peroral Endoscopy Myotomy (G-POEM)

What is Gastroparesis?

Gastroparesis is a motility disorder of the stomach that results in delayed emptying of stomach contents into the intestines.  The stomach is a large bag-shaped organ that receives and digests oral food contents both mechanically and with the assistance of acid secretion.  The stomach has many nerve fibers that help signal its muscle fibers to contract and help push that food through into the intestines. In gastroparesis, these signals are abnormal and there is a lack of strong coordinated muscular contractions in the stomach which results in prolonged retention of acid, liquid and solid contents in the stomach.  

What are the Symptoms of Gastroparesis?

This can lead to a variety of debilitating symptoms such as recurrent nausea, vomiting, abdominal bloating, fullness, acid reflux/heartburn, weight loss, and lack of appetite.  

How is Gastroparesis Treated?

Gastroparesis is a difficult disease to treat as there are not extremely effective medications to affect stomach motility. Often dietary measures including eating smaller meals and less fatty foods can improve symptoms of gastroparesis.  There are some medications that help with motility of the stomach, but often their efficacy is limited and they can have side effects. Gastric nerve stimulators (gastric pacers) are implantable devices that may be placed surgically to help with symptoms but do not actually improve the motility of the stomach.

What is a G-POEM?

Recently a new endoscopic therapy called “gastric peroral endoscopy myotomy or G-POEM” has been introduced.  The concept of the G-POEM is to use an endoscope to open the distal muscular valve of the stomach known as the pylorus.  By opening the pylorus by way of cutting its muscle fibers, the ability of the stomach to empty contents can be augmented and result in clinical symptom improvement for the patient.  The G-POEM is a non-surgical, endoscopic procedure that takes less than 2 hours and results in significant symptom improvement of 70-80% of gastroparesis patients. Patient typically stays one night in the hospital after G-POEM.

What Should I do Before the G-POEM Procedure?

You will have specific instructions from your physician about what you need to do prior to the procedure. Generally, the main preparation is to have a clean stomach – devoid of solid food debris so that the working space is clean for the procedure.  To achieve this, your endoscopist may ask for you to be on a liquid diet for 24-48 hours prior to the procedure.

What is the G-POEM Procedure Like?

All G-POEM procedures are performed under general anesthesia, thus the patient will not feel any pain or remember the procedure.  Once the patient is sedated, the endoscopist will insert the endoscope into your mouth where it will travel down your stomach to the area that requires the procedure. Using specialized instruments and precise maneuvers, the endoscope will dissect down to the muscle of the pylorus (distal stomach) and cut that muscle.  All incisions into the stomach lining will be closed with clips or sutures.  After the procedure, the patient will recover from anesthesia with no skin incisions as all of the intervention is from inside the body.

What Can I Expect Post Procedure?

After the G-POEM procedure is complete, you will be taken into a recovery room until the sedation has worn off. At that time, your doctor will come in and discuss the procedure with you. This is when you will be admitted into the hospital for monitoring.

The next morning you will have a barium x-ray to assure that there is an adequate passage of contents through the stomach and no leakage from any of the incisions. If the x-ray is normal than the patient will be discharged and begin a slow progression of diet.

G-POEM in Dallas, Tx

Are you interested in learning more about G-POEM, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.

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