Gastric Per-Oral Endoscopic Myotomy (G-POEM)

Gastric Per-Oral Endoscopic Myotomy (G-POEM) is a minimally invasive, endoscopic technique developed to treat medically refractory gastroparesis. Gastroparesis is a disorder that affects the stomach’s ability to properly empty food into the small bowel.  This leads to symptoms of nausea, vomiting, abdominal pain, bloating, distension, and feeling of fullness after eating. Gastroparesis occurs most commonly in people with diabetes, after abdominal or gastric surgeries, viral infections, from certain medications, and at times for reasons that are unknown (termed “idiopathic”). The pylorus is a muscle that helps to open and close the opening to the small intestine and is thought to contribute to the symptoms of gastroparesis. This muscle is cut during a GPOEM procedure to make food and liquid passage easier.

G-POEM uses an endoscope that is inserted into the mouth and advanced to the stomach. A small incision in the lining of the stomach will be made, and the pylorus will be cut using an endoscopic knife. The incision is then closed using specialized clips.

You should drink liquids only for 48 hours before the procedure to ensure solid food is not sitting in your stomach, and take nothing by mouth for 8 hours prior to the procedure.

If you are on blood thinning medications/anticoagulants (such as Plavix, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban etc.), please notify the office of the doctor who is performing your procedure. They will give you specific instructions on whether or not you should stop your blood thinner before the procedure.

G-POEM is a safe procedure. Risks of G-POEM include bleeding, infection, side effects of the medications used to put you to sleep, or perforation. Perforation is very rare but could result in the need for an emergency surgery. Excess carbon dioxide in the abdominal cavity, called capnoperitoneum, may occur and is managed by decompression with a small needle during the procedure.

Will I have to stay in hospital?

You will be kept in hospital for monitoring overnight and will be discharged the following morning after a special X-Ray study is performed to ensure there is no leakage from around the incision in the stomach.

Will I have a scar?

Since POEM is performed through a tube that is inserted into the mouth, you will not have a scar on your skin.

Your physician will instruct you on which medications to take after the procedure.

You should advance your diet slowly over the coming weeks:

• Day 1: You will have nothing by mouth the day of your procedure.
• Day 2 and 3: You can have thin liquids and gellatins (eg: Jello, popsicles) the day following your procedure.
• Day 4-7: Advance diet to thick liquids (eg: soups, pudding, smoothies).
• Day 7: You can advance your diet to soft solids, as tolerated, which should be continued for another 2 weeks before advancing to full solids.

You may have ongoing discomfort with eating for upwards of 10 days after the procedure. You should continue to take your medications as prescribed

Return to the Emergency Room if you experience any of the following:

• Throwing up or vomiting blood
• Bloody or black, tarry bowel movements
• Severe abdominal pain or chest pain
• Intractable nausea or vomiting
• Fever > 38.5°C

You will have a follow-up phone call with your physician 1 month after the procedure.