Long known for leading-edge care for gastrointestinal conditions, UHealth – the University of Miami Health System is launching a new treatment option for severe gastroparesis, a disorder that can cause chronic digestive tract difficulties.
“Patients with gastroparesis typically have feelings of nausea, episodic vomiting or abdominal bloating because the stomach is unable to empty normally after a meal,” said Enrico Oliveira Souto, M.D., assistant professor of gastroenterology at the University of Miami Miller School of Medicine. “One of the causes is a failure of the pylorus valve, at the base of the stomach, to open and close correctly.”
UHealth’s experienced specialists have several options to treat gastroparesis, including medications, electrical stimulation, botox injections, and now an advanced endoscopic procedure called G-POEM, for gastric peroral endoscopy myotomy.
“G-POEM is a minimally invasive procedure for opening the pylorus,” said Sunil Amin, M.D., M.P.H., assistant professor of gastroenterology 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, according to Il J. Paik, M.D., assistant professor of gastroenterology and director of the GI Motility Program. “About 20 to 30 percent of patients with gastroparesis have problems with the pylorus, and may be candidates for G-POEM,” he said. “We use our knowledge to pinpoint the issues with the GI tract, so we can tailor our treatment appropriately.”
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.
Dr. Souto said G-POEM is a new application of an endoscopic procedure originally developed to remove cancerous lesions from the intestine without surgery. “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 said.
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, said 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.”