G-POEM

G-POEM

G-POEM (Gastric Peroral Endoscopic Myotomy) is an advanced minimally invasive endoscopic procedure used primarily to treat selected patients with gastroparesis, a condition in which the stomach empties food more slowly than normal. G-POEM works by relaxing the pylorus, the muscular valve that controls the passage of food from the stomach into the small intestine.

Gastroparesis can cause persistent nausea, vomiting, early fullness, bloating, abdominal discomfort, and difficulty maintaining adequate nutrition. When symptoms remain severe despite appropriate medical treatment, G-POEM may be considered as an advanced therapeutic option for carefully selected patients.

Unlike conventional surgery, G-POEM is performed through the mouth using a flexible endoscope and does not require an external abdominal incision.

Our G-POEM service provides advanced endoscopic treatment for appropriately evaluated patients with symptomatic gastroparesis and selected disorders associated with impaired gastric emptying.

What Is Gastroparesis?

Gastroparesis is a disorder in which the stomach takes longer than normal to empty its contents into the small intestine.

Normally, coordinated contractions of the stomach muscles move food toward the pylorus. The pylorus then relaxes intermittently to allow partially digested food to pass into the small intestine.

In gastroparesis, stomach emptying can become delayed. This may occur because of problems involving the nerves or muscles responsible for normal stomach movement, or due to other underlying conditions.

Common symptoms include:

  • Nausea
  • Vomiting
  • Feeling full after eating a small amount
  • Prolonged fullness after meals
  • Bloating
  • Upper abdominal discomfort
  • Reduced appetite
  • Difficulty maintaining adequate nutrition
  • Unintentional weight loss in some patients

Symptoms can significantly affect eating habits, daily activities, and quality of life.

What Role Does the Pylorus Play?

The pylorus is a muscular valve located between the stomach and the first part of the small intestine.

It helps regulate the movement of stomach contents into the intestine. In some patients with gastroparesis, the pylorus may remain excessively tight or fail to relax appropriately, contributing to delayed gastric emptying.

G-POEM is designed to reduce resistance at the pylorus by dividing selected muscle fibres.

By creating a controlled opening through the pyloric muscle, the procedure aims to facilitate the passage of stomach contents into the small intestine.

How Does G-POEM Work?

G-POEM is based on the principles of third-space endoscopy.

During the procedure, a small opening is created in the lining of the stomach, usually a short distance from the pylorus. The specialist then creates a submucosal tunnel within the stomach wall toward the pyloric muscle.

Once the pylorus is reached, the specialist carefully divides the appropriate muscle fibres. This is known as a pyloromyotomy.

After the myotomy is completed, the entry point in the stomach lining is closed using endoscopic clips.

The procedure is performed entirely through the mouth, without an external surgical incision.

Who May Benefit From G-POEM?

G-POEM may be considered for selected patients with significant gastroparesis symptoms, particularly when symptoms persist despite dietary modifications, medications, and other appropriate treatments.

A careful evaluation is required before recommending the procedure.

Assessment may include:

  • Detailed medical and symptom history
  • Upper gastrointestinal endoscopy
  • Gastric emptying testing
  • Blood tests when appropriate
  • Imaging or other investigations to exclude mechanical obstruction
  • Review of previous medical treatment
  • Evaluation of nutritional status

The cause and severity of gastroparesis, the patient’s symptoms, and the function of the pylorus are considered when determining whether G-POEM may be appropriate.

Causes of Gastroparesis

Gastroparesis can have several causes.

Common causes or associations include:

  • Diabetes
  • Previous stomach or upper abdominal surgery
  • Certain neurological or systemic disorders
  • Medications that slow gastric emptying
  • Post-viral or other unexplained causes

In some patients, no clear underlying cause is identified. This is sometimes referred to as idiopathic gastroparesis.

Identifying and addressing the underlying cause remains an important part of comprehensive treatment.

What to Expect During G-POEM

G-POEM is performed in a specialized endoscopy unit under general anesthesia or deep sedation.

Before the procedure, your specialist will review your symptoms, medical history, medications, allergies, previous investigations, and nutritional status.

You will generally need to follow specific fasting instructions before the procedure. Patients with significantly delayed gastric emptying may require a modified preparation plan because food can remain in the stomach for longer than expected.

During the procedure, the endoscope is passed through the mouth into the stomach. The specialist creates a small entry point in the gastric lining and develops a submucosal tunnel toward the pylorus.

The pyloric muscle is then divided using specialized endoscopic instruments.

Once the treatment is completed, the entry site is closed with endoscopic clips.

You will be monitored after the procedure and may require observation in hospital depending on your condition and the clinical protocol.

Benefits of G-POEM

For appropriately selected patients, G-POEM may offer several potential advantages:

  • Minimally invasive treatment
  • No external abdominal incision
  • Direct treatment of the pyloric muscle
  • Potential improvement in nausea and vomiting
  • Potential improvement in post-meal fullness and bloating
  • Potential improvement in gastric emptying
  • Shorter recovery compared with some surgical approaches
  • Ability to perform treatment through a standard endoscopic route

The degree of symptom improvement varies between patients, and G-POEM does not guarantee complete resolution of gastroparesis.

G-POEM Compared With Surgical Pyloroplasty

Surgical pyloroplasty is another approach used to modify the pylorus and improve gastric drainage.

G-POEM achieves a similar therapeutic goal through an endoscopic approach. Instead of making an external abdominal incision, the specialist accesses the pylorus through the stomach using a submucosal tunnel.

For appropriately selected patients, this minimally invasive approach may offer a shorter recovery and avoid the need for conventional surgery.

However, the most suitable treatment depends on the patient’s diagnosis, anatomy, previous treatments, overall health, and the expertise available.

Recovery After G-POEM

After G-POEM, patients are monitored for potential complications and are usually advanced through a carefully planned diet according to the treating team’s recommendations.

The initial diet may consist of liquids before gradually progressing to soft foods and eventually a more regular diet, depending on recovery.

Your specialist may recommend medication and dietary measures during the recovery period.

Follow-up is important to assess symptom improvement and nutritional status. In selected patients, repeat gastric emptying assessment may be considered.

Risks and Possible Complications

G-POEM is an advanced endoscopic procedure and carries potential risks.

Possible complications include:

  • Bleeding
  • Infection
  • Leakage from the gastric entry site
  • Perforation
  • Abdominal pain or discomfort
  • Gas-related complications
  • Adverse reactions to anesthesia or sedation
  • Incomplete symptom improvement
  • Recurrence or persistence of gastroparesis symptoms

Patients with significant medical conditions may have additional risks.

Your specialist will explain the potential benefits, risks, alternatives, and expected recovery before the procedure.

Long-Term Management After G-POEM

G-POEM is one component of gastroparesis management. Patients may continue to benefit from dietary modifications, appropriate medications, nutritional support, and treatment of underlying conditions.

For patients with diabetes, maintaining appropriate blood glucose control is particularly important because blood sugar levels can influence gastric emptying and gastroparesis symptoms.

A dietitian or other specialist may be involved when nutritional intake has been significantly affected.

Why Specialist Expertise Matters

G-POEM requires advanced therapeutic endoscopy skills and detailed knowledge of gastric and pyloric anatomy. Careful patient selection is essential because delayed gastric emptying can have multiple causes, and not every patient with gastroparesis will benefit from pyloric intervention.

Our G-POEM service provides advanced minimally invasive treatment for selected patients with symptomatic gastroparesis and related disorders. The goal is to improve gastric drainage, reduce troublesome symptoms, support nutritional health, and improve quality of life while avoiding conventional surgery when an endoscopic approach is appropriate.

If you experience persistent nausea, vomiting, early satiety, bloating, or have been diagnosed with gastroparesis that has not responded adequately to conventional treatment, specialist evaluation can help determine whether G-POEM may be a suitable treatment option for you.