John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Endoscopic treatment of refractory gastroparesis Volume 26, issue 1, Janvier 2019

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Authors
Hôpital Nord, Départements de Gastroentérologie, d’Endoscopies Digestives et d’Explorations fonctionnelles digestives, Service de gastroentérologie, Aix-Marseille Université, AP-HM, Chemin des Bourrelys, 13015 Marseille
* Correspondance
  • Key words: gastroparesis, endoscopy, dilation, botulinium toxin, G-POEM, pyloromyotomy
  • DOI : 10.1684/hpg.2018.1723
  • Page(s) : 34-41
  • Published in: 2019

Gastroparesis is a motility disorder relatively frequent, with a growing impact on the public health. The three main causes are represented by diabetes, post-operative and idiopathic gastroparesis. The symptoms of the disease are various, due to the delayed gastric emptying, which is confirmed by an endoscopy (bezoar) and a gastric emptying scintigraphy. The treatment aiming at increasing the gastric motility, including medication or intervention such as electric stimulation, have been disappointing. Recently, endoscopic targeted on antro-pyloric hypertonia; endoluminal techniques such as: pyloric stenting, which seemed interesting, but remains hardly applicable because of very high rate of stent migration; hydraulic dilatation, evaluated in one single series, appears to temporarily improve the pyloric compliance (ENDOFLIP®) and the symptoms ; intra-pyloric injection of botulinium toxin that was a very promising approach in several preliminary reports, but two recent randomized study failed to demonstrate a difference against placebo. However, it was effective for 4 to 6 months. Even more recently, submucosal endoscopy with G-POEM (Gastric Peroral Endoscopic Myotomy) brings a real novelty in the therapeutic arsenal, especially in terms of clinical efficacy. It consists of performing a submucosal tunnel by dissection up to the pyloric area, then a pylorotomy and finally a closure of the mucosal tear. To date, eight studies have evaluated this new technique and the pooled analysis showed an efficacy rate of 70-85%, with a low rate of severe adverse events (<10%), which explains its current worldwide expansion. Although more studies are necessary to confirm these very promising results, G-POEM already has a growing place in the therapeutic strategy, associated or not to electrical stimulation.