Navigating Gastroparesis: Is G-POEM a Viable Option?

August is Gastroparesis Awareness Month, a time to shed light on a condition that can be profoundly disruptive and challenging to manage. For those living with gastroparesis, the path to relief is often long and frustrating, paved with dietary trials, medications, and persistent symptoms like nausea, bloating, and debilitating fullness. When these first-line treatments fail to provide adequate quality of life, it’s natural to search for other options. One advanced procedure that has gained significant attention is the Gastric Peroral Endoscopic Myotomy, or G-POEM.

While you may see stories of it being “life-changing,” it’s crucial to approach this procedure with a realistic, informed perspective. Let’s take a balanced look at what G-POEM is, who it might help, and what to realistically expect.

The Core Problem: Understanding Gastroparesis

Gastroparesis, which translates to “stomach paralysis,” is a disorder where the stomach takes too long to empty its contents into the small intestine. This isn’t due to a physical blockage but rather to improper muscle contractions (motility). This delay can be caused by damage to the vagus nerve, often as a complication of diabetes or previous surgeries. However, in a large number of cases, the cause is unknown (idiopathic).

Standard treatment begins with dietary modifications (small, frequent, low-fat, low-fiber meals) and medications (prokinetics and antiemetics) to manage symptoms. For many, this is enough. But for those with severe, or refractory, gastroparesis, these measures fall short, leaving them to seek more definitive interventions.

What is G-POEM?

G-POEM is a minimally invasive endoscopic procedure designed to address the “exit” of the stomach. It specifically targets the pylorus, a muscular valve that controls the flow of food from the stomach into the small intestine. In many gastroparesis patients, the pylorus either fails to relax properly or spasms, effectively holding food hostage in the stomach.

During a G-POEM procedure:

1. A gastroenterologist guides a flexible endoscope through the patient’s mouth, down the esophagus, and into the stomach. There are no external incisions.
2. A specialized knife at the tip of the endoscope is used to make a small incision in the innermost lining (mucosa) of the stomach, several centimeters away from the pylorus.
3. The endoscope is advanced through this opening into the space between the stomach’s lining and its deeper muscle layers, creating a submucosal tunnel.
4. Once the endoscope reaches the pyloric muscle through this tunnel, the physician carefully cuts the muscle fibers (a myotomy). This permanently relaxes the pyloric valve.
5. The initial entry point in the stomach lining is then closed with small clips. By cutting this restrictive muscle, the procedure creates a wider, more passive opening for food to exit the stomach, relying more on gravity than on failed muscular contractions.

Setting Realistic Expectations: Efficacy and Outcomes

While G-POEM can be profoundly effective for many, it is not a universal cure, and the term “life-changing” must be framed with clinical data.

Success is typically measured in two ways:

• Symptom Improvement: Studies use a scoring system called the Gastroparesis Cardinal Symptom Index (GCSI) to track nausea, fullness, bloating, and vomiting. A majority of well-selected patients see a significant reduction in their GCSI score. Clinical success rates in published studies often range from 60% to 70%.
• Objective Improvement: This is measured by a gastric emptying scan, which tracks how quickly a standardized meal leaves the stomach. Most patients show significantly faster emptying times after G-POEM.

For a patient like Stacey Latham, the results can indeed feel transformational. She shares:

“I was eating maybe only 200–300 calories a day until Dr. Sunkavalli came along with the POEM. It has changed my life! I am able to eat. I am able to swallow without choking. I am no longer having to go get fluids. I am absorbing my water! I am back to walking 3 to 4 miles a day. I feel the best I have ever felt in my life!”

Stacey’s incredible outcome highlights the powerful potential of G-POEM when a patient is an ideal candidate. However, it’s important to recognize that individual results vary. A successful procedure might mean a return to near-normal eating for one person, while for another, it could mean being able to maintain hydration and nutrition without a feeding tube, even if some symptoms persist. It is a significant step forward, but not always a complete erasure of the condition.

Risks and Considerations

No procedure is without risk. G-POEM is considered safe when performed by a highly trained therapeutic endoscopist, but potential complications, though uncommon, can include:

• Bleeding
• Infection
• Perforation (a small tear in the stomach or duodenal wall)
• Air leaking into the abdominal cavity (pneumoperitoneum), which usually resolves on its own.
• Worsening or new-onset gastroesophageal reflux disease (GERD), as altering stomach mechanics can sometimes affect the valve at the top of the stomach.

Is G-POEM right for you?

G-POEM is a specialized procedure for a specific patient population. You may be a candidate if:

• You have a confirmed diagnosis of gastroparesis with objectively delayed gastric emptying.
• Your symptoms are severe and have not responded adequately to dietary changes and multiple medications.
• You and your gastroenterologist have ruled out other potential causes for your symptoms.

The decision to proceed with G-POEM is a significant one that requires a thorough consultation and evaluation. It’s a powerful tool in our arsenal against severe gastroparesis, offering a durable, minimally invasive solution that can dramatically improve a patient’s daily life.

Ready to take the next step?

If you are living with debilitating gastroparesis and feel you’ve exhausted other options, a consultation can help determine if G-POEM is an appropriate next step for you. Dr. Madhusudhan Sunkavalli performs this procedure at Prisma Health Greenville Memorial Hospital.

To schedule a consultation specifically about G-POEM, please contact Gastroenterology Associates at 864-232-7338.

For other gut health concerns, text 864-589-6714 or schedule a visit with one of our providers.

Written by Dr. Madhusudhan Sunkavalli, Gastroenterologist