Submucosal technology for safe third space procedures: Amber-Red Color Imaging-guided Gastric-PerOral Endoscopic myotomy for idiopathic refractory gastroparesis

Refractory gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. For patients unresponsive to maximal medical therapy, gastric peroral endoscopic myotomy (G-POEM) has emerged as a minimally invasive treatment targeting pyloric dysfunction [1] [2]. We report the case of a 60-year-old man with idiopathic refractory gastroparesis referred for G-POEM. Radiological and motility studies confirmed delayed gastric emptying without evidence of obstruction. The procedure was performed using the Fujifilm EG-860R gastroscope (outer diameter 8.9 mm, working channel 2.8 mm) and the ELUXEO 8000 processor. HybridKnife T-type (Erbe Elektromedizin GmbH, Tübingen, Germany) was used for all procedural steps. Mucosotomy was performed along the greater curvature, followed by submucosal tunneling and full-thickness myotomy of the circular fibers of the pyloric sphincter [3]. The mucosal entry was closed using standard endoscopic clips ([Video 1]).