Post-surgical gastroparesis and beyond: The expanding role of G-POEM in foregut surgery complications and obesity care

Gastroparesis is a debilitating motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction.Although idiopathic and diabetic etiologies predominate, an important subset of patients develop gastroparesis following surgery, most commonly due to vagal nerve injury or pyloric dysfunction.These post-surgical cases are often refractory to medical therapy, prompting interest in minimally invasive interventions such as gastric peroral endoscopic myotomy (G-POEM).This review explores the application of G-POEM in post-surgical gastric dysfunction, focusing on gastroparesis after Nissen fundoplication, esophagectomy, pylorus-preserving Whipple, sleeve gastrectomy, and lung transplantation.It also highlights the evolving role of pyloric myotomy in managing gastric sleeve complications and in metabolic therapy for obesity via gastroplasty with endoscopic myotomy (GEM).A narrative review of the literature was conducted, synthesizing mechanistic data, clinical features, and outcomes across post-surgical subtypes.Emerging interventions such as stricturotomy and GEM were also examined.G-POEM has shown promising efficacy in treating gastroparesis after lung transplantation and esophagectomy, with clinical success rates exceeding 75% and improvements in symptom burden, gastric emptying, and nutritional status.In patients who have undergone sleeve gastrectomy, G-POEM appears effective for sleeve-associated functional obstruction, though data remain limited.Evidence for G-POEM following Nissen fundoplication and pancreaticoduodenectomy is sparse but suggests potential benefits in select cases.GEM, a hybrid technique combining antral myotomy with sleeve gastroplasty, has demonstrated early success as a weight loss intervention by inducing delayed gastric emptying.G-POEM is an emerging intervention with growing utility in post-surgical gastroparesis.The strongest evidence currently exists in lung transplant and esophagectomy populations, and further research is needed to define its role following fundoplication and Whipple surgery.Expanded applications in sleeve complications and obesity highlight the versatility of pyloric-directed endoscopic therapy.