PROVIDENCE, R.I. — Gastroparesis is a chronic and debilitating gastrointestinal issue for which there is no cure. Fortunately, there are treatments that can help those with the condition find relief.
One of those treatments is per-oral pyloroplasty–or POP for short. The incision-free procedure helps treat gastroparesis with a shorter hospital stay, quicker recovery, and a lower risk of complications.
Marcoandrea Giorgi, MD, a minimally invasive surgeon at Brown Surgical Associates, along with BSA colleague Andrew Luhrs, MD, and Lifespan’s Dr. Zilla Hussain, were the first to perform the procedure in Rhode Island and Southeastern Massachusetts several years ago.
POP Procedure
Gastroparesis affects the stomach muscles and prevents proper stomach emptying.
Like traditional myotomy, the pyloric muscle is cut during a POP myotomy. However, this groundbreaking treatment doesn’t require incisions. Instead, it is performed endoscopically through the mouth with a camera.
“Left untreated, patients with gastroparesis have a significant decrease in quality of life, with the potential of malnutrition, with frequent bloating, nausea, vomiting, regurgitation, and inability to eat and sustain themselves,” said Dr. Giorgi. “This procedure is a game-changer because it eliminates the need for incisions in the abdomen – minimizing pain and potential complications, resulting in a shorter hospital stay.”
With this innovative myotomy technique, the surgeon endoscopically starts by cutting the inner layer of the stomach, the mucosa, close to the pyloric muscle. A tunnel is created within the wall of the stomach until the pylorus is visualized. Then, using an energy device through the endoscope within the tunnel, the pylorus is cut, allowing easier passage of food through it. At the end of the procedure, the endoscope is withdrawn from the tunnel previously created letting it collapse, and the initial access site on the mucosa is closed with endoscopic clips.
This procedure is an option for any patient diagnosed with gastroparesis via a gastric emptying study and who hasn’t undergone a traditional myotomy. Even some of those who have undergone traditional myotomy may be candidates. The POP myotomy does not preclude further potential operations, so it can be offered as a safe, early option.
