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World J Gastroenterol. Jun 7, 2019; 25(21): 2581-2590
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2581
Gastric per-oral endoscopic myotomy: Current status and future directions
Alexander Podboy, Joo Ha Hwang, Linda A Nguyen, Patricia Garcia, Thomas A Zikos, Afrin Kamal, George Triadafilopoulos, John O Clarke
Alexander Podboy, Joo Ha Hwang, Linda A Nguyen, Patricia Garcia, Thomas A Zikos, Afrin Kamal, George Triadafilopoulos, John O Clarke, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: John O Clarke, MD, Associate Professor, Clinical Associate Professor, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor, MC: 6341, Redwood City, CA 94063, United States. john.clarke@stanford.edu
Telephone: +1-650-721-6190 Fax: +1-650-724-0533
Received: January 6, 2019
Peer-review started: January 7, 2019
First decision: January 18, 2019
Revised: April 25, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 7, 2019
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: Gastroparesis, Gastric per-oral endoscopic myotomy, Per-oral endoscopic pyloromyotomy, Myotomy, Endoscopic myotomy, Peroral endoscopic myotomy, Gastric emptying

Core tip: While data regarding the role of per-oral endoscopic pyloromyotomy (G-POEM) for the treatment of gastroparesis are still emerging, it is a promising technique that may significantly benefit specific gastroparesis subtypes with functional gastric outlet obstruction. More data are needed, however, to determine exactly where G-POEM falls in the armamentarium of gastroparesis treatment strategies.