Gastric Peroral Endoscopic Myotomy: An Overview
Introduction and Terminology
Gastric Peroral Endoscopic Myotomy, or POEM, is an innovative, minimally invasive endoscopic procedure designed to help manage and alleviate symptoms of a condition called Gastroparesis. Gastroparesis is characterized by a delayed emptying of the stomach’s contents, often leading to persistent nausea, vomiting, and abdominal pain.
As a relatively new procedure, the Gastric POEM has shown remarkable results in clinical practice and has steadily gained acceptance in the United States. According to recent data, the use of Gastric POEM has increased significantly, providing relief to thousands of patients suffering from this condition.
It’s essential to understand some terminologies related to the procedure. ‘Peroral’ means through the mouth, ‘Endoscopic’ involves the use of a flexible tube with a light and camera, and ‘Myotomy’ refers to the cutting of muscle. In the Gastric POEM, the endoscope goes through the mouth to cut the muscle in the stomach that prevents proper digestion.
Indications for Gastric Peroral Endoscopic Myotomy
Gastric POEM can be a suitable treatment option for Gastroparesis under a variety of conditions. Here are some key indications:
- Medically refractory Gastroparesis: When standard medications fail to alleviate Gastroparesis symptoms or cause adverse effects, Gastric POEM may be considered.
- Idiopathic Gastroparesis: This is a type of Gastroparesis where the cause is unknown. Gastric POEM can provide significant relief for these patients.
- Gastroparesis from Diabetes: Diabetes is one of the leading causes of Gastroparesis. When blood sugar levels are poorly controlled, Gastric POEM can be a viable treatment option.
- Postsurgical Gastroparesis: Gastroparesis can occur as a complication after certain surgical procedures. Gastric POEM can be beneficial for these patients.
- Connective tissue disorders: In some patients with diseases like scleroderma, Gastroparesis can occur. Gastric POEM may offer relief.
It’s vital to discuss these indications with your doctor to understand if Gastric POEM is the right treatment for you.
Pre-Op Preparation
Preparing for a Gastric POEM procedure involves several steps to ensure your safety and the success of the procedure.
You may be asked to fast for several hours before the procedure. Adjustments to your current medications may also be needed, including temporary discontinuation of certain medications. Always consult your doctor regarding any changes to your medication regimen.
Before the procedure, pre-operative labs or imaging may be ordered for further assessment. It is also important to arrange for transportation after the procedure, as you may be temporarily unable to drive. You may also need a note for work or school, indicating your need for a brief period of recovery.
Ensure that you receive pre-clearance authorization for the procedure. It’s important to note that our telemedicine primary care practice can assist with pre-operative clearances and ordering of pre-op labs and imaging.
Please remember, each patient’s circumstance is unique, and these guidelines may not apply to everyone. Always consult with your healthcare provider for personalized pre-operative preparation instructions.
Disclaimer: This article is meant for informational purposes only and should not be taken as medical advice. Always consult your doctor for personalized medical advice.
Step-by-Step Explanation of the Gastric POEM Procedure
The Gastric Peroral Endoscopic Myotomy, or POEM, is an intricate procedure carried out in several specific stages. To aid your understanding, we’ve broken down the complex steps into simpler, easy-to-understand explanations.
1. Anesthesia and Preparation
The procedure begins with you being administered general anesthesia, which means you will be asleep and won’t feel any pain during the procedure. A small device called an endotracheal tube is then inserted into your windpipe to help you breathe. Once you are asleep, your throat is carefully numbed with a local anesthetic to ensure comfort and safety.
2. Insertion of the Endoscope
Next, your doctor will gently guide a long, thin tool called an endoscope through your mouth and down your esophagus. This endoscope has a light and a tiny camera on its tip, allowing your doctor to see inside your digestive tract on a monitor.
3. Making an Incision in the Mucosa
The doctor then creates a small incision in the lining of your stomach, known as the mucosa. This incision is the starting point for creating a tunnel using the endoscope.
4. Creating a Submucosal Tunnel
From the incision, a submucosal tunnel is created. This tunnel goes down to the point where the stomach muscle requires treatment. The endoscope is used to navigate this path, and it helps to protect the rest of the stomach and esophagus from injury.
5. Performing the Myotomy
Once the tunnel is created, the doctor begins the ‘myotomy’ part of the procedure. This involves selectively cutting the layers of the muscular wall of the stomach that are causing the symptoms of Gastroparesis. This cutting eases the muscle’s tightness and allows the stomach to empty its contents into the small intestine more efficiently.
6. Closure of the Mucosal Entry Point
After the myotomy is complete, the doctor withdraws the endoscope back through the tunnel. The entry point in the mucosa is then closed with special clips to prevent any potential complications like bleeding or perforation.
7. Completion of the Procedure
Finally, the endoscope is carefully withdrawn from the body. At this point, the procedure is complete.
The Gastric POEM is a highly specialized procedure that requires a skilled and experienced doctor to perform. Despite the complexity, the procedure is minimally invasive and typically results in a quicker recovery time than traditional surgical methods.
Remember, while this is a detailed step-by-step guide, each person’s procedure may vary slightly based on their specific medical circumstances. Always consult with your doctor to understand exactly what will occur during your procedure.
Disclaimer: This article is meant for informational purposes only and should not be taken as medical advice. Always consult your doctor for personalized medical advice.
Duration of Gastric Peroral Endoscopic Myotomy
The Gastric Peroral Endoscopic Myotomy procedure usually takes between two to three hours. However, the exact duration can vary depending on individual patient conditions and the complexity of the case.
Post-Op Recovery from Gastric Peroral Endoscopic Myotomy
After the procedure, you will likely stay in the hospital for 1 to 2 days for observation and recovery. Your doctor will schedule a follow-up visit within a few weeks to monitor your progress and address any concerns. There is no specific physical therapy needed for this procedure. However, you might be advised to adapt your eating habits gradually over the course of a few weeks to allow your stomach to adjust to the changes.
Recovery time varies, but many people can return to work and normal activities within 2 weeks. Complete recovery often takes around a month, depending on individual circumstances. Our primary care practice is here to support you during this period. We offer same-day appointments up until 9pm on weekdays and 5pm on weekends should you need school or work notes or additional assistance.
Effectiveness of Gastric Peroral Endoscopic Myotomy
Gastric Peroral Endoscopic Myotomy has been shown to be highly effective in treating Gastroparesis. Studies have reported that over 80% of patients experience significant improvement in their symptoms after the procedure. These outcomes can be influenced by various factors, including the severity of Gastroparesis, patient’s overall health, and the skill and experience of the doctor performing the procedure.
Certain situations can enhance the effectiveness of the procedure. For instance, early intervention, when the symptoms of Gastroparesis are less severe, often results in better outcomes. Adherence to post-procedure dietary guidelines also contributes to optimal results.
Conversely, some factors might lower the effectiveness of the procedure. These include more severe cases of Gastroparesis, the presence of other gastrointestinal diseases, or complications during the procedure. Your doctor will discuss all these factors with you to provide a personalized estimation of the effectiveness of the procedure in your specific case.
Remember, it’s important to discuss your medical history and any concerns you may have with your doctor before the procedure. This allows your healthcare team to make any necessary adjustments to optimize the procedure’s effectiveness.
Disclaimer: This article is meant for informational purposes only and should not be taken as medical advice. Always consult your doctor for personalized medical advice.
Adverse Events with Gastric Peroral Endoscopic Myotomy
Although Gastric Peroral Endoscopic Myotomy (POEM) is generally a safe procedure, like any medical intervention, it carries potential risks and adverse events. It’s important to be aware of these possibilities. The following adverse events may occur:
- Perforation of the stomach or esophagus (2-5% occurrence): Perforation is a rare but serious complication where a hole may form in the stomach or esophageal wall during the procedure. This can lead to leakage of stomach contents into the abdomen and may require further intervention, such as surgery.
- Bleeding (1-2% occurrence): Bleeding can occur during or after the procedure, requiring additional medical attention or intervention to stop the bleeding.
- Pneumonia or other respiratory infections (1-2% occurrence): In some cases, pneumonia or other respiratory infections may develop after the procedure, particularly in patients with compromised lung function or those who have difficulty swallowing.
- Gastroesophageal reflux (10-20% occurrence): Some patients may experience an increase in gastroesophageal reflux symptoms, including heartburn and regurgitation, after the procedure.
It’s important to note that these adverse events occur in a small percentage of cases and can often be effectively managed with appropriate medical intervention. Additionally, the mortality rate associated with Gastric POEM is extremely low, estimated to be less than 0.1%.
Alternatives to Gastric Peroral Endoscopic Myotomy
While Gastric POEM is an effective treatment option for Gastroparesis, there are alternative approaches available. These alternatives may be considered depending on individual patient circumstances and preferences. Some alternatives to Gastric POEM for Gastroparesis include:
- Medication: Depending on the severity of symptoms, medications such as prokinetic agents, antiemetics, and anti-reflux medications may be prescribed to manage Gastroparesis symptoms.
- Dietary modifications: Adjusting your diet by consuming smaller, more frequent meals and avoiding foods that trigger symptoms can help alleviate Gastroparesis symptoms.
- Gastric electrical stimulation: This procedure involves the implantation of a device that delivers electrical impulses to the stomach, helping to regulate its movement and improve gastric emptying.
It’s essential to discuss these alternatives with your doctor to determine the most suitable treatment approach for your specific case.
Experimental or Emerging Technologies
In addition to established procedures like Gastric POEM, there are experimental or emerging technologies being explored for the treatment of Gastroparesis. One such technology is gastric neurostimulation, where electrodes are implanted in the stomach to stimulate the nerves and improve gastric motility. These emerging technologies show promise in providing alternative treatment options for patients with Gastroparesis.
Conclusion
Gastric Peroral Endoscopic Myotomy (POEM) is a proven and effective procedure for managing Gastroparesis. While it carries potential risks, the occurrence of adverse events is relatively low. It’s important to be aware of alternative treatment options, such as medications, dietary modifications, and emerging technologies, which may be considered based on individual circumstances. Discuss these options with your doctor to make an informed decision about the most suitable treatment approach for you. Your healthcare team is here to provide support and guide you through the process.
Disclaimer: This article is meant for informational purposes only and should not be taken as medical advice. Always consult your doctor for personalized medical advice.
Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.