Gastric per-oral endoscopic myotomy: Indications, technique, results and comparison with surgical approach

Table 2 Surgical and endoscopic options

	PRO	CONS
Surgical options
Pyloromyotomy	(1) High technical success rate; and (2) Improvement in GCSI and GES	(1) Risk of gastric outlet obstruction and leakage; (2) Invasive; and (3) Time consuming
Electrical stimulator	(1) Test response with temporary device; and (2) Predictive features are male sex, diabetic etiology and short duration of disease	High rate of long term complications (infection, erosion, migration, perforation and chronic pain)
Endoscopic options
Botulinum toxin	(1) Easy and tolerable procedure; (2) Repeatable; and (3) Predictive for response to other pyloric techniques	(1) Moot in literature; and (2) Can induce sclerosis and anatomic alteration of pyloric region
Pyloric stent placement	(1) Temporized technique; and (2) Predictive for response to other pyloric targeted techniques	Risk of stent migration and duodenal perforation

GCSI: Gastroparesis cardinal symptoms index; GES: Gastric electrical stimulator.