Severe gastroparesis is a disorder that can cause chronic digestive tract difficulties in patients.
“Patients with gastroparesis typically have feelings of nausea, episodic vomiting or abdominal bloating because the stomach is unable to empty normally after a meal,” says Enrico Oliveira Souto, M.D., gastroenterologist at the University of Miami Health System. “One of the causes is a failure of the pylorus valve, at the base of the stomach, to open and close correctly.”
There are several options to treat gastroparesis, including:
- electrical stimulation
- botox injections,
- G-POEM, gastric peroral endoscopy myotomy – an advanced endoscopic procedure
“G-POEM is a minimally invasive procedure for opening the pylorus,” says Sunil Amin, M.D., M.P.H., gastroenterologist and director of endoscopy at The Lennar Foundation Medical Center. “This endoscopic approach can offer significant improvements to a patient’s lifestyle, and it expands our options for treating medically refractory gastroparesis.”
Drawing on the resources of the Miller School’s comprehensive endoscopy laboratory, the UHealth specialists can evaluate motility – how well food moves through the patient’s entire digestive tract – as well as the severity of symptoms based on the Gastroparesis Cardinal Symptom Index (GCSI).
Because gastroparesis has many causes, an accurate diagnosis is crucial for determining the best course of treatment,
“About 20 to 30% of patients with gastroparesis have problems with the pylorus, and may be candidates for G-POEM,” says Il J. Paik, M.D., gastroenterologist and director of the GI Motility Program. .
For instance, Dr. Paik can use a wireless capsule or “smart pill” to measure temperatures, pressures, and transit time throughout the entire GI tract. “It’s a very benign diagnostic method that gives us plenty of data on the stomach and its ability to empty.” If the pylorus appears to be the problem, Dr. Paik can perform a procedure called ENDOFLIP to assess the characteristics of the valve including diameter and distensibility.
G-POEM is a new application of an endoscopic procedure originally developed to remove cancerous lesions from the intestine without surgery, says Dr. Souto. “We are one of the few centers in Florida offering the G-POEM procedure, which facilitates the emptying of the stomach contents and so alleviates symptoms,” he says.
Some patients with gastroparesis have underlying conditions such as diabetes or obesity, or have undergone prior surgery, which can contribute to a poorly functioning pylorus, says Dr. Amin. “Patients who have been receiving temporary botox injections to relax the pylorus may be good candidates for the G-POEM procedure,” he added. “When gastroparesis is not responding to medical management, our team can evaluate the options and determine the best form of treatment.”
Original written by Richard Westlund for Inventum.
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