Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Yervant Ichkhanian; Joo Ha Hwang; Andrew Ofosu; Andrew A Li; Daniel Szvarca; Peter V Draganov; Dennis Yang; Eva Alsheik; Tobias Zuchelli; Cyrus Piraka; Shruti Mony; Mouen A Khashab

doi:10.1055/a-1797-9587

Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Endosc Int Open. 2022 Jun 10;10(6):E832-E839. doi: 10.1055/a-1797-9587. eCollection 2022 Jun.

Authors

Affiliations

¹ Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan, United States.
² Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States.
³ Johns Hopkins Hospital, Department of Internal Medicine, Baltimore, Maryland, United States.
⁴ Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States.
⁵ Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States.
⁶ Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States.

Abstract

Background and study aims Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.

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