Gastric per-oral endoscopic myotomy (G-POEM) for the treatment of gastric sleeve stenosis: a feasibility and safety study

Background/aims: Traditional endoscopic treatments have limited success for treatment of gastric sleeve stenosis (GSS). Gastric peroral endoscopic myotomy (G-POEM) could conceivably obliterate the twist/angulation that causes GSS through a tunneled stricturotomy (instead of pyloromyotomy). We report early outcomes of G-POEM for GSS treatment. Methods: We retrospectively reviewed all patients with GSS treated with G-POEM at a single center. The primary endpoint was clinical success, defined as symptom improvement with resumption of adequate oral intake, without requiring further intervention. Results: 13 patients (12 female, mean age 43±10.9 years) underwent G-POEM for predominantly helical (n=11, 85%) GSS. Three (23%) had concurrent sleeve leak and ten (77%) had prior GSS treatment. There were two intraoperative AEs resulting in no deviation to the procedure. No major AEs occurred. At a median 175 (IQR119-260) days follow up, clinical success was achieved in 10 patients (77%). Median GCSI score in responders decreased post-G-POEM from 2.06 (IQR1.5-2.8) to 0.39 (IQR0.2-0.5). Three patients (23%) required surgical revision. Conclusions: G-POEM is a feasible and safe technique which may provide an alternative option for those averse to undergoing surgical revision for treatment of GSS.