Gastric per-oral endoscopic pyloromyotomy in the treatment of refractory gastroparesis: Report on the first case performed in Mexico

Gastroparesis is a syndrome characterized by a delay in gastric emptying, in the absence of mechanical obstruction. Its main symptoms are: nausea, vomiting, and early satiety. Idiopathic etiology is the most frequent, but postoperative and metabolic (diabetes mellitus) etiologies have also been regularly documented. The criterion standard for diagnosis is gastric emptying scintigraphy, in which a standardized diet radiomarked with 99m TC colloidal sulfur is ingested, obtaining images at 0, 60, 120, 180, and 240 min. Emptying delay is defined as > 10% gastric retention in 4 h. Treatment consists of controlling symptoms and improving emptying. The response rate of dietary and drug modifications, including metabolic control in diabetic patients, is low (< 20%). Intrapyloric botulinum toxin injection, a current treatment, has a temporary and poor response rate (1520%). Surgical management includes electric stimulation, pyloroplasty, and total or subtotal gastrectomy, with regular results (40-60%) and high morbidity and mortality. Per oral endoscopic myotomy (POEM) is a technique that was developed for the treatment of achalasia, and has shown good safety and efficacy. The idea of performing an endoscopic pyloromyotomy (G-POEM) was recently developed, utilizing the basic components of POEM to improve gastric emptying through gravity, despite the presence of gastroparesis. Initial results on different populations, including a multicenter study, have shown good safety and efficacy in humans (> 80% initial response). Gastroparesis is a frequent pathology in the Mexican population. The aim of this report was to describe the case of a Mexican patient with refractory gastroparesis treated with the G-POEM procedure.