LAUSR

INTRODUCTION For medically refractory diabetic or idiopathic gastroparesis, gastric electrical stimulation (GES) is an excellent option for symptom control; however, a small subset of patients may develop recurrent or persistent symptoms. Per-oral pyloromyotomy (POP) (also described by some authors as gastric per-oral endoscopic myotomy or G-POEM) is an emerging therapy for medically refractory gastroparesis. This study investigated safety and feasibility of POP after prior GES for recurrent or persistent gastroparesis. METHODS All patients undergoing POP between January 2016 and December 2017 with GES in situ were retrospectively identified. Patient characteristics, gastroparesis etiology, and procedural data were collected. Symptoms were assessed with the Gastroparesis Cardinal Symptom Index (GCSI) both before and 30-90 days after POP. Standard pre- and post-procedure 4-hour gastric emptying tests were obtained when available. RESULTS There were 22 patients who met inclusion criteria (81.8% female, mean age 42.3±12.4 years). Cause of gastroparesis was diabetes in 38.1%, and idiopathic in 61.9%. The average time since GES insertion was 3.45 years. Mean pre-operative 4-hour gastric retention was 50.1%. Most POP procedures were performed in the operating room (90.9%) with mean operative time of 40 minutes and a 1.4 day length of stay. There were 4 readmissions within 30 days, but no POP related complications. Overall GCSI improved by 1.63 (p=0.002), with significant improvements in all subscores. Of 11 patients with post-procedural motility or emptying studies available, 7 were normal. CONCLUSION POP appears to be safe and feasible for patients with recurrent gastroparesis symptoms after GES. Both symptoms and motility significantly improved in the short-term. This data replicates similar data suggesting laparoscopic pyloroplasty as an effective augmentative therapy after GES, but may provide a less invasive option for patients.