Intramural Surgery: Per Oral Pyloromyotomy

Intramural surgery has opened the door to exciting, minimally invasive solutions to surgical problems. The treatment of gastroparesis, a debilitating disease of the gastrointestinal tract, has been revolutionized by intramural surgery. The endoscopic surgeons who pioneered this innovative therapy, following in the footsteps of the surgeon who revolutionized the technique of per oral endoscopic myotomy for achalasia, have coined the acronyms “G-POEM (gastric per oral endoscopic myotomy)” and “POP (per oral pyloromyotomy).” It has been several years since the first human model of POP, and the data accrued suggest it is an efficacious gastric emptying procedure—improving both quantitative and qualitative measures of gastroparesis. This disorder, including the idiopathic, diabetic, and post-surgical forms, decreases the quality of life of the patients whom it affects. Over the last two decades, healthcare utilization has increased immensely related to gastroparesis. Herein, the development of the per oral pyloromyotomy will be discussed, the specifics of our techniques will be shared, and the current literature and ongoing studies will be reviewed.