Gastric Peroral Endoscopic Myotomy for Treatment of Congenital Pyloric Stenosis-First Clinical Experience

Traditionally, a laparoscopic approach is used for treatment of congenital hypertrophic pyloric stenosis (CHPS) in newborns and infants. The novel technique-Gastric Per Oral Endoscopic Myotomy (G-POEM) had been proposed as an alternative method. G-POEM is a procedure that is recently being used for treatment of gastroparesis in adults. For the first time, in this study, we demonstrate the performance of G-POEM in an infant and its short-term results. G-POEM was performed in the Center of Newborn Surgery in Irkutsk (Russia) in August 2018 for a 1-month-old infant, whose weight was 4,200 g. The patient had vomiting for 5 days before admission and a slight deficiency of body weight. The diagnosis of CHPS was confirmed by ultrasound examination of the abdominal cavity. The pyloric muscle thickness was 7 mm. The operative technique of the performed G-POEM was carried out by creation of a submucosal tunnel with a distance of 4 cm toward the pylorus and dissection of the hypertrophied muscle layer in a form of the Ramstedt's incision by using an electrocautery knife. At the end of the procedure, the mucosal membrane incision was closed by special clamps. The operating time was 65 minutes. There were no intraoperative complications such as bleeding and/or mucosal perforation. The patient began to eat 6 hours after the procedure. The transition time to full enteral nutrition was 24 hours. The infant was discharged from the hospital the next day in good condition. We did not observe early or late postoperative complications such as recurrence of pyloric stenosis and incomplete myotomy during postoperative observation. There were not even minimal scars on the patient's body. G-POEM is a technically feasible, safe, and successful procedure for treatment of CHPS in newborns and infants. An additional study is needed to perform the comparison between this technique and laparoscopic pyloromyotomy.