S6356 Dumping Syndrome: A Rare Temporary Side Effect of G-POEM

Introduction: Gastric peroral endoscopic myotomy (G-POEM ) is a minimally invasive endoscopic procedure developed as treatment for patients with refractory gastroparesis. By cutting the pyloric muscle, G-POEM aims to reduce pyloric resistance and improve gastric emptying. Dumping Syndrome is a condition that can occur following surgical procedures that alter the stomach such as gastric bypass or partial gastrectomy which is characterized as rapid transit of hyperosmolar gastric contents into the small intestine leading to a range of gastrointestinal and vasomotor symptoms. We present a case of dumping syndrome in a patient that underwent G-POEM. Case Description/Methods: Sixty-five-year-old woman with a past medical history of Type 2 diabetes, insulin dependent, hypertension, and arthritis who presented for a long-standing history of gastroparesis. Gastric emptying study was performed which confirmed gastroparesis. Esophagogastroduodenoscopy showed retained food in the stomach. Based on the symptoms she described, a gastroparesis cardinal symptom index (GCSI) score was calculated at a 4. After a goals-of-care discussion with the patient, she agreed to undergo a G-POEM procedure. G-POEM was performed where mucostomy followed by double-cut myotomy of 3 centimeters was performed on the greater curvature of the stomach from the pylorus. Patient tolerated the procedure well and there was minimal bleeding. 1-2 days after the procedure, the patient was having complaints of multiple episodes of diarrhea which the patient took loperamide 2 mg 2-3 times a day without relief. Patient described as soon as she consumed a meal she would pass it. Upon discussion with the patient, she was advised to take 4 mg of loperamide 3 times a day, increase fiber intake, and decrease the size of meals. Following this and a few days later, the patient's symptoms resolved. Discussion: Dumping syndrome is well documented in procedures such as Roux-en-y gastric bypass or sleeve gastrectomy where management involves dietary modifications including smaller, frequency meals and pharmacology therapy. We believe this patient had experienced dumping syndrome after the G-POEM. The syndrome is very uncommon and not well-documented after G-POEM. Our senior author, Qiang Cai, has performed near 500 G-POEMs and this was the first possible dumping syndrome he has seen in his patient pool. This potential side-effect should be further studied and discussed with patients prior to the procedure.