G-POEM or “gastric peroral endoscopic myotomy”
G-POEM is an endoscopic procedure that widens the muscular valve at the outlet of the stomach, and is typically performed for gastroparesis that has not responded to medication and dietary measures. It is performed entirely through the mouth, with no incisions on the abdomen, and it is usually a one-night stay or, in selected cases, a day procedure.
The problem it addresses
In gastroparesis, the stomach empties too slowly, causing nausea, vomiting, fullness after only a few bites, bloating, and upper abdominal pain. Part of the problem in many people is the pylorus — the ring of muscle at the stomach outlet — which fails to relax properly and holds food back.
G-POEM cuts that muscle ring from the inside, so it no longer acts as a barrier. This is the same principle as an operation called pyloroplasty, but achieved without surgery.
G-POEM treats the outlet. It does not restore normal contraction of the stomach itself, which is why the response to G-POEM varies between people and why the underlying condition still needs ongoing management afterward.
Who this is for
G-POEM is considered when gastroparesis is confirmed and has not responded to standard treatment. Before proceeding, three things are established: an endoscopy showing no physical blockage, a gastric emptying scan confirming genuinely delayed emptying, and symptoms that are moderate to severe — particularly nausea and vomiting, which respond best.
Expectations
G-POEM helps a majority of appropriately selected people, and the technical procedure itself succeeds in essentially everyone. In a randomized trial comparing it against a placebo procedure, 71% improved with G-POEM versus 22% with the placebo at six months — a clear and real effect.
But the response is not universal and not always durable. A careful international study following 80 patients found that 56% of patients still had a meaningful improvement in symptoms at one year. Other studies report better figures than that, but in cany case it’s important to know that some patients do not see a lasting benefit after G-POEM.
Symptoms and scan results do not always move together. Some people feel considerably better while the emptying scan remains slow, and that is still a good result. The reverse also happens.
The procedure
G-POEM is typically performed under general anesthesia, usually taking under an hour.
A small cut is made in the lining of the stomach a few centimeters before the pylorus.
A tunnel is created beneath the lining, running down toward the pylorus.
The pyloric muscle is divided from within the tunnel.
The entry point is closed with clips, which cause no symptoms. The clips pass on their own over the following weeks.
Risks
Complications occur in roughly 5 or 10 out of 100 people, and most are minor and managed at the time of the procedure. Reported problems include bleeding, a small leak of air or fluid outside the stomach, ulceration at the site, and injury to the lining of the tunnel.
Because the procedure effectively creates an ulcer in the stomach wall, acid-suppressing medication is usually given afterward while the area heals.
Afterward
Most people stay one night. A liquid diet is started once things look stable, sometimes after an X-ray with contrast to confirm no leak.
Diet is then advanced gradually, commonly full liquids for around 5 to 7 days, then small, frequent, low-fat and low-fiber meals.
An acid-suppressing medication is usually prescribed for about 8 weeks, and a short course of antibiotics is sometimes given.
Improvement is not always immediate. Some people notice a change within days; for others it develops over several weeks.
Follow-up after G-POEM.
Ongoing care for your gastroparesis is typically with your general gastroenterologist or motility specialist, and continuing with them is essential rather than optional. Gastroparesis is a chronic condition, and G-POEM addresses one component of it. Other steps that may be required in the future:
Adjusting antiemetic and prokinetic medications as symptoms change
Managing nutrition and weight, with dietitian input where needed
Optimizing blood sugar control in diabetes, which itself affects gastric emptying
Monitoring for and managing reflux, dumping, or new symptoms
Recognizing a loss of response early, and deciding what comes next
Please make sure an appointment with your regular gastroenterologist or motility specialist is arranged within a few months after your G-POEM.
Suggested reading
The International Foundation for Gastrointestinal Disorders maintains plain-language patient information on gastroparesis, including diet guidance and treatment options: aboutgastroparesis.org