Gastric per-oral endoscopic myotomy: Current status and future directions

Abstract

Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.

Keywords: Endoscopic myotomy; Gastric emptying; Gastric per-oral endoscopic myotomy; Gastroparesis; Myotomy; Per-oral endoscopic pyloromyotomy; Peroral endoscopic myotomy.

Figure 1

Per-oral endoscopic pyloromyotomy procedure in 5 steps. A: Initial inspection; B and C: Mucosotomy; D: Submucusal tunnel dissection with identification of pyloric ring; E: Pyloromyotomy; F: Mucosal closure.