LAUSR

OBJECTIVE Endoscopic resection of more than three-fourths of the lumen of the antrum or pylorus is a known risk factor for post-endoscopic submucosal dissection (ESD) stenosis. Local or systemic steroids may reduce the risk for stenosis, but their overall role in stenosis prevention remains controversial. We examined the safety and efficacy of prophylactic gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-ESD stenosis. METHODS We examined 10 patients who underwent GO-POEM during or immediately after ESD in Presbyterian Medical Center between June 2017 and November 2020. All patients underwent excision of more than three-fourths of the lumen of the antrum or pylorus. GO-POEM was performed without submucosal tunneling. RESULTS Well-differentiated tubular adenocarcinoma, tubulovillous adenoma with high-grade dysplasia, and tubular adenoma with low-grade dysplasia were diagnosed in three, one, and six patients, respectively. GO-POEM was performed successfully in all 10 patients. Stenosis could not be evaluated in one patient, whereas one of the remaining nine patients developed post-ESD stenosis; GO-POEM was protective against post-ESD stenosis in the other eight patients. Two patients presented with intra-procedural bleeding; both cases were managed well endoscopically. CONCLUSIONS Prophylactic GO-POEM may be a new, effective and safe treatment modality for preventing post-ESD stenosis in the stomach. Well-designed, multicenter studies with larger sample sizes are needed to confirm the results. This article is protected by copyright. All rights reserved.