Question of the Week: G-POEM for Gastroparesis

Shabir asked: “I like to know right at this moment how long will it be when everyone who suffers from diabetic gastroparesis will get a g poem procedure when that seems to be the best solution and another thing I like to ask is why is there so little treatment options for diabetic gastroparesis in this day and age when there are so many people suffering. Thank you looking forward to hearing from”.

Dear Shabir,

G-POEM stands for gastric per-oral endoscopic myotomy. The pyloric muscle is cut open using special endoscopic instruments inserted through the mouth. The advantage of such an approach over traditional pyloromyotomy is lack of incisions. This translates into faster recovery due to decreased post-operative pain and discomfort. That doesn’t mean, however, higher success rate for treatment of gastroparesis. Gastric drainage procedures like pyloroplasty and gastro-jejunostomy are associated with more failure than success rates. Gastroparesis is a heterogeneous and complex motility disorder. Curing gastroparesis entails re-establishing some form gastric motility to favor gastric content emptying. Pyloroplasty whether it is done open, laparoscopic or endoscopic, does not restore motility. Consequently, food lingers in the stomach and does not empty in most cases. Adding a fundoplication increases the success rate of pyloroplasty. Adding a gastric body resection along the greater curvature and moving the pacemaker towards the antrum and possible resetting the Magenstrasse emptying pathway seem to be the most effective solution for gastroparesis. Unfortunately, this observation is limited to my personal experience dealing with a number of gastroparesis cases over the past 10 years of my professional career. I cannot pretend that I have the cure for gastroparesis. Nonetheless, the success rate of my surgical approach, antrum preserving modified longitudinal gastrectomy, in this small group of gastroparesis patients was 100%.

The incidence and prevalence of gastroparesis is expected to rise secondary to the diabetes epidemic. You are absolutely right, not much research is conducted in this field. Gastrointestinal dysmotility is a crucial player in the pathogenesis of obesity, type 2 diabetes, and GERD. All 3 diseases have reached epidemic proportions in this day and age. Deciphering the complexity of gastric emptying and the pathogenesis of gastroparesis is needed to help patients. So far, we have more questions than answers. Unfortunately, we still don’t have clear guidelines for effective gastroparesis treatment.