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

Table 2 Demonstrates procedural data including equipment used and post-operative practice reported across the studies

Article	Shlomovitz et al[25], 2014	Gonzalez et al[26], 2017	Kahaleh et al[27], 2018	Rodriguez et al[28], 2017	Rodriguez et al[29], 2018	Malik et al[30], 2018	Jacques et al[31], 2017	Dacha et al[32], 2017	Mekaroonkamol et al[33], 2018	Khashab et al[34], 2017
n	7	29	33	47	100	13	20	16	30	30
Procedure length (min)	90-1201	47 ± 22	77.6 (37-255)	41.2 ± 28.5	33.8 ± 21.6	119 ± 23	56.5	49.7 ± 22.1	48.3 ± 16.5	72 ± 42
Length of stay (mean)	2.3	—	5.4 (1-14)	1.09 ± 0.6	1.3 ± 1.05	2.5 ± 1.4 d	3.75	2.46	2.4 ± 1.0	—
Pre ABX	Yes, IV	Yes, IV	Gentamicin wash	None	None	Gentamicin wash	None	Yes, IV	Yes	Post-Op
Site of mucosotomy (cm proximal to pylorus)	5	5	5-6	5	4	5	4-5	5	5-7	5
Mucosal entry location	greater curvature in 31, 2 patients lesser curvature.	Greater curvature 19, anterior wall 9, posterior wall 2	greater curvature	—	95 lesser curvature, 4 greater, 1 posterior	greater curvature	greater curvature	lesser curvature	—	—
Lift Solution	5-10 mL 1: 10000 Epi	—	5 mL methylene blue and 500 saline mixture	methylene blue6	methylene blue	Not used	glycerol	5 mL methylene blue and 500 saline mixture	—	saline and 0.25% indigo carmine solution or methylene blue solution2
Size of mucsoal incision (cm)	1-2	—	2	2	—	—	—	2	3-4	1.5-2
Knife Used	T Knife	Triangle knife	Hybrid knife or IT2	Triangular knife	triangle tip knife	I-Type Hybrid knife	T-Type for initial incision, Hybrid knife for tunnel, Hook Knife for myotomy	Hook Knife or I-type knife	I hybrid knife	Triangular tip knife
Size of myotomy mean (cm)		2	3.34 (2-6)	—	—	3.5 ± 0.8	—	3.94	2-3	—
Upper GI series	—	—	—	POD 1	POD 1	POD 1-2	—	POD 1	POD 1	POD 1
Use of PPI	BID PPI for 6 wk	BID PPI for 4 wk	—	PPI BID for 4 wk w/Sucralfate	BID PPI and QID sucralfate for at least 2 wk	—	—	—	BID for 8 wk
Antibiotics on discharge	—	—	—	—	—	—	—	5 d oral Abx	—	IV Abx following procedure
Dietary restrictions	Clear liquid immediately, pureed/soft diet for 2 wk,	observed for 1 d NPO, then advanced to clears, observed for 5 d and sent home on	Clear liquid diet 2-3 d, advanced to gastroparetic diet	advanced to clears with liquid diet for 2 wk	liquid diet for 2-4 wk	Clear liquid diet, advance as tolerated	Liquid diet day after procedure	advance to liquid after upper GI and ADAT	clear liquid and advanced diet over 4 wk course	liquid diet started then advanced to soft then to gastroparetic diet
Total of major post operative complications	4/7	5/29	1/33	0/47	10/100	1/13	3/20	0/16	1	2/30

¹Time to myotomy;

²No specified amount; GCSI: Gastroparesis Cardinal Symptom Index; GES: Gastric Emptying Study; CPGAS: Clinical Patient Grading Assessment Scale; G-POEM: Per-oral endoscopic pyloromyotomy; BID Twice daily; PPI: Proton Pump Inhibitor; ABX: Antibiotics; IV: Intravenous; POD: Post operative day; NPO: Nil per os; ADAT: Advance diet as tolerated.