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What is Gastric Peroral Endoscopic Myotomy (G-POEM)?

Gastric refers to the stomach, peroral means through the mouth, endoscopic means performed through an endoscope, and myotomy means cutting the muscle.

Gastric peroral endoscopic myotomy (G-POEM) is a minimally invasive surgical procedure to treat gastroparesis. It is performed using an endoscope which is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end.

In G-POEM, an endoscope is introduced into your stomach through the mouth. After positioning it properly, a small cut is made in the inner lining of your stomach and a tiny tunnel-like path is created underneath to cut the muscles right down till the pylorus. Then, the cut in your stomach lining is sealed to avoid any perforations or holes.

What is Gastroparesis?

Gastroparesis is a condition where the gastric contents do not pass through the stomach easily and empty at a very slow pace. Gastroparesis occurs due to a defect in the pylorus – the valve between your stomach and small intestine – when it does not work properly. G-POEM aims to relax the pyloric sphincter muscles present at the junction of the stomach and the small intestine to facilitate movement of food.

What are the Indications and Contraindications for Gastric Peroral Endoscopic Myotomy (G-POEM)?

Gastric peroral endoscopic myotomy (G-POEM) surgery is recommended for the treatment of:

  • Gastroparesis
  • Achalasia: a rare disorder where food and liquid is unable to pass through the esophagus into your stomach

Gastric peroral endoscopic myotomy (G-POEM) is not recommended for:

  • People who have had a major gastrointestinal surgery in the past that leaves their gastrointestinal tract compromised or without a pylorus
  • Pregnant women
  • People with severe bleeding disorders

Pre-Surgical Preparation for Gastric Peroral Endoscopic Myotomy (G-POEM)

Before scheduling gastric peroral endoscopic myotomy (G-POEM) surgery, your gastroenterologist will perform a thorough medical examination.

  • You may be required to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • Inform your doctor about your:
    • Allergies
    • Current medications, vitamins, or supplements
  • Avoid:
    • Blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
    • Smoking and drinking at least a week before and two weeks after surgery.
  • Do not consume solid food or liquids at least 8 hours prior to surgery.
  • You may be given a laxative based upon your doctor’s discretion.

Gastric Peroral Endoscopic Myotomy (G-POEM) Procedure

Gastric peroral endoscopic myotomy (G-POEM) involves the following steps:

  • You are placed on the operating on your back or on your side based on your doctor’s discretion.
  • General anesthesia is administered so you will be asleep during the surgery.
  • Your blood pressure, oxygen level, and pulse are monitored continuously before, during, and after the procedure.
  • The endoscope is inserted into your gastrointestinal tract via your mouth.
  • Carbon dioxide gas is pumped through the oral cavity for better visualization of the internal structures through the endoscope.
  • A tiny incision is made in the internal lining of the esophagus. This allows penetration of the endoscope within the walls of the esophagus to expose the pyloric sphincter muscles.
  • An electrosurgical knife or an electrocautery device is used to cut the inner layer of the muscles near the lower esophageal sphincter till it touches the pylorus.
  • A tunnel-like pathway is created which gives space for the movement of food from the stomach to the pylorus.
  • The esophageal incision is sealed using standard endoscopic clips.
  • The endoscope is removed.

The entire procedure may take around 2-3 hours.

Post-surgical Care for Gastric Peroral Endoscopic Myotomy (G-POEM)

You are required to stay in the hospital for 2-3 days after the procedure until the effect of the general anesthesia wears off and you can move around without any pain.

  • You will be on a liquid diet after the surgery which will be gradually be advanced to soft foods. Your doctor will give instructions regarding when you can resume your normal diet.
  • You will be given pain-relieving medications and antibiotics either through an IV or orally.
  • You are required to visit your doctor for a follow-up consultation after the procedure to ensure there are no complications.

What are the Risks and Complications of Gastric Peroral Endoscopic Myotomy (G-POEM)?

Gastric peroral endoscopic myotomy (G-POEM) may have certain risks and complications such as:

  • Reaction to the general anesthesia
  • Bleeding
  • Perforation (hole) in your stomach wall
  • Carbon dioxide gas escape

What are the Benefits/Advantages of Gastric Peroral Endoscopic Myotomy (G-POEM)?

Gastric peroral endoscopic myotomy (G-POEM) is effective in providing symptomatic relief from gastroparesis. Other benefits include:

  • No external skin incision
  • Safe
  • Well tolerated
  • Shorter recovery period compared to surgery

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