G-POEM: non-invasive pyloroplasty

by Jim Sliney Jr

For patients whose primary symptoms of gastroparesis are nausea and vomiting, and in whom other gastric procedures have failed, there is a hopeful procedure and a related study going on.

G-POEM stands for Gastric per-oral Endoscopic Myotomy, which is a procedure using endoscopy (a camera attached to a tube that, in this case, goes down your throat and into your stomach) to perform myotomy, which is the cutting of muscle tissue. In this procedure the pyloric sphincter, which is the muscle between the stomach and the small intestine which is meant to open and close to let food out or keep it in as needed, is cut allowing a wider vent for food to leave the stomach. The desired result of a G-POEM procedure is to improve the gastric emptying rate which in turn should reduce the nausea and vomiting which are associated with slow gastric emptying.

I spoke with Dr. Mouen Khashab, the Director of Therapeutic Endoscopy at Johns Hopkins Medical Center, and the principal investigator of a study that looks at the safety of the G-POEM procedure and its effectiveness over the course of two-years. Dr. Khashab explained that not everyone is a good candidate for G-POEM, noting that only those who present with nausea and vomiting as their primary symptoms would be right for his study. However, the procedure is showing itself to be effective to relieve nausea, vomiting, and to a lesser degree, abdominal pain, while improving the rate of gastric emptying.

Pyloroplasty is a similar procedure, the goal of which is also to cut the pyloric sphincter allowing for food to leave the stomach faster. There are also stent placing procedures designed to do this. The primary difference between pyloroplasty, stent placement and G-POEM is that pyloroplasty is performed laparoscopically (a small incision is made in the wall of the abdomen and an instrument is inserted through it) while G-POEM is non-invasive. Also, stents run a risk of moving over time, losing their effectiveness and requiring follow up procedures.

diagram_showing_the_parts_of_the_stomach_cruk_336-svg

Dr. Kenneth Koch, Director of the Digestive Health Center of Wake Forest School of Medicine (and member of the medical advisory board of G-PACT) added that patients with pyloric dysfunction, a subgroup of GP patients, might benefit from procedures like G-POEM and pyloroplasty since pyloric dysfunction is associated with delayed gastric emptying, which in turn is associated with nausea and vomiting.

Dr. Khashab recently presented the results of his study at an international meeting of gastroenterologists and has an article in the Gastrointestinal Endoscopy journal. His findings include the following:

During the first six months of observation after the G-POEM procedure,

  • 47% of the patients reported that their nausea was completely resolved and 50% reported that it was improved, while one patient reported that nausea was worsened.
  • 57% of patients reported their vomiting was resolved, while 10% reported improvement. 33% reported no change to vomiting while 1 patient reported worsening of vomiting symptom.
  • 53% of patients reported that abdominal pain was resolved, 20% said it improved, 23% reported no change, and 1 patient reported worsening of abdominal pain.

Of note, the patients in this study had gastroparesis either from diabetes, post-surgery, or of unknown origin. The 1 patient who reported worsening of nausea, vomiting and abdominal pain had diabetic gastroparesis.

Studies investigating the safety and effectiveness of G-POEM as a treatment for GP related nausea and vomiting are ongoing, including Dr. Khashab’s study.

If your primary GP symptoms are nausea and vomiting and you have tried different therapies and they have not worked, and you wish to consider Dr. Khashab’s study. You can learn more about it and how to contact Dr. Khashab by following this link .

 

Jim Sliney Jr is the Editor for ThePactBlog, G-PACT’s newsletter. He is a part time student at Columbia University and a freelance writer, working in both fiction and medical writing. He lives in New York City with his wife, an ophthalmic researcher.

*graphics from creative commons

2 thoughts on “G-POEM: non-invasive pyloroplasty

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s