Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)

• Published in: Journal of digestive diseases 2022-04, Vol.23 (4), p.220-227
• Main Authors: Lee, Won Dong, Song, Jae Sun, Kim, Byung Sun, Yang, Min A., Lee, Young Jae, Jung, Gum Mo, Kim, Ji Woong, Cho, Yong Keun, Cho, Jin Woong
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenoma; Adenoma - etiology; Adenoma - surgery; Constriction, Pathologic - etiology; Dysplasia; Endoscopic Mucosal Resection - adverse effects; endoscopic submucosal dissection; Endoscopy; gastric peroral endoscopic myotomy; Humans; Myotomy; Patients; Risk factors; Stenosis; Steroid hormones; Stomach; Treatment Outcome; Tumors
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.13094

Objective Endoscopic resection of over 3/4 of the lumen of the antrum or pylorus is a known risk factor for post‐endoscopic submucosal dissection (ESD) stenosis. Local or systemic steroids may reduce the risk of stenosis, but their overall role in stenosis prevention remains controversial. We aimed to evaluate the efficacy and safety of prophylactic gastric open peroral endoscopic myotomy (GO‐POEM) in preventing post‐ESD stenosis. Methods Ten patients who underwent GO‐POEM during or immediately after ESD in the Presbyterian Medical Center between June 2017 and November 2020 were included. All patients underwent excision of over 3/4 of the lumen of the antrum or pylorus. GO‐POEM was performed without submucosal tunneling. Results Well‐differentiated tubular adenocarcinoma, tubulovillous adenoma with high‐grade dysplasia, and tubular adenoma with low‐grade dysplasia were diagnosed in three, one, and six patients, respectively. GO‐POEM was performed successfully in all the 10 patients. Stenosis could not be evaluated in one patient, whereas one of the remaining nine patients developed post‐ESD stenosis. GO‐POEM decreased the risk of post‐ESD stenosis in the other eight patients. Two patients presented with intraprocedural bleeding, both of whom were managed endoscopically successfully. Conclusions Prophylactic GO‐POEM may be a novel, effective and safe treatment modality for preventing post‐ESD stenosis in the stomach. Well‐designed, multicenter studies with large sample sizes are needed to confirm our results. This retrospective study evaluated the safety and effectiveness of gastric open peroral endoscopic myotomy (GO‐POEM) in the prevention of post‐ESD gastric stenosis. Patients at high risk for post‐ESD stenosis were examined, and selective myotomy of the circular muscle was performed without submucosal tunneling. GO‐POEM significantly prevented post‐ESD gastric stenosis.