Letter to the Editor: Initial Experience with Endoscopic Pyloromyotomy, with Description and Video of Technique

Excerpt

We read with interest the article by Hedberg et al. whom reported their initial experience of endoscopic pyloromyotomy (G-POEM) combined with measures of pyloric distensibility with Endoflip before and after procedure.¹ The physiopathology of gastroparesis is complex and involves gastric and/or pyloric motor dysfunction. Gastric emptying scintigraphy allows for confirming the diagnosis of gastroparesis, defined as the percentage of remaining radioisotope at 2 h (%2) > 60% and at 4H (%H4) > 10%.² Pylorospasm or increase pyloric tone is one of the causes of delayed gastric emptying. The significant increase of pyloric distensibility after G-POEM, reported by Hedberg et al., is very encouraging and objectively confirms the interest of G-POEM in the management of gastroparesis with low pyloric distensibility. This method of evaluation of pyloric distensibility could complete the interpretation of gastric scintigraphy and help to select the best responder to G-POEM as suggested by Jacques et al..³ With this series, Hedberg et al. confirm the first promising results of G-POEM in gastroparesis with improvement symptoms in more than 70%^3‐5 of case. However, a digestive neuropathy can also be involved in a delayed gastric emptying. Gastric electrical stimulation (GES) is another therapeutic option for management of gastroparesis resistant to medical therapy. Some studies have reported an improvement in symptoms, particularly on nausea and vomiting, in 70% of patients at 6 and 12 months.^{6, 7} However, GES has suffered from its high cost and its adverse events that have limited its development.⁸ …