Doctors sometimes use a special camera procedure called G-POEM to help people whose stomachs don’t empty food properly (a condition called gastroparesis). This study looked at three patients who needed the procedure done twice because their symptoms came back. While the procedure itself was safe and didn’t cause major problems, all three patients eventually struggled with their symptoms returning or got worse. Two needed permanent feeding tubes, and one didn’t improve at all. This suggests that doing the procedure a second time might not be the best solution for everyone with this stomach problem.

The Quick Take

  • What they studied: Can a special camera procedure to help with stomach emptying problems work a second time if symptoms come back after the first procedure?
  • Who participated: Three patients (average age 52 years) who had a stomach emptying condition that didn’t improve enough after their first G-POEM procedure and needed it done again
  • Key finding: All three procedures were completed safely without major complications, but all three patients eventually experienced treatment failure—their symptoms either came back or never improved, and two needed permanent feeding tubes
  • What it means for you: If you have a stomach emptying problem and are considering this procedure, doing it a second time may not be reliable. Doctors need to carefully think about whether this is the right choice for each person, and other treatment options should be explored.

The Research Details

This was a case report study, which means doctors looked back at medical records of patients they treated at their hospital between 2008 and 2024. They found three patients who had a special camera procedure called G-POEM (a way to help the stomach muscles work better) done twice because their stomach problems came back after the first procedure.

The doctors collected information about each patient’s age, what caused their stomach problem, what treatments they tried before, how bad their symptoms were, and whether their stomach was actually emptying food better after the procedures. They also looked at special tests that measure how fast food leaves the stomach.

This type of study is like a detailed story about what happened to specific patients rather than a large experiment comparing many people. It helps doctors understand what might happen in unusual situations, but it can’t prove that something will or won’t work for everyone.

This research matters because gastroparesis is a serious condition that can really affect people’s quality of life, and doctors need to know which treatments actually help. When a first procedure doesn’t work well enough, doctors need to know whether trying it again is worth it. This study shows what happened when doctors tried this approach, which helps them make better decisions about whether to recommend it to other patients.

This study has some important limitations to understand: it only looked at three patients, which is a very small number. The study looked backward at what already happened (called retrospective), rather than following patients forward over time. Because there are so few patients and they had different types of stomach problems, it’s hard to say what would happen to other people. However, the study does provide honest information about real patient experiences, which is valuable for doctors thinking about treatment options.

What the Results Show

All three patients successfully completed the second G-POEM procedure without major surgical complications, and all went home safely from the hospital. However, the long-term results were disappointing.

Patient A had a stomach problem caused by sarcoidosis (a disease affecting the body’s immune system). After the first procedure, her stomach emptying improved for a while, but her symptoms came back within a year. When doctors did the procedure again, her stomach went back to not emptying well. She eventually needed a permanent feeding tube placed directly into her small intestine.

Patient B had an unknown cause for his stomach problem and had received a kidney transplant. The procedure didn’t improve his stomach emptying at all—it stayed about the same before and after both procedures. He didn’t follow dietary recommendations and sadly passed away two years after the second procedure from a heart rhythm problem.

Patient C had stomach problems after previous abdominal surgery. The first procedure helped her stomach empty better, but it got worse again over time. The second procedure made her feel better symptomatically, but she still couldn’t eat normally and needed permanent nutrition through an IV until she passed away four years later.

An important finding was that there was often a disconnect between how patients felt and whether their stomach was actually working better. Patient C felt better after the second procedure, but tests showed her stomach still wasn’t emptying properly. This suggests that the procedure might help with pain or discomfort in some cases, but it doesn’t always fix the underlying stomach problem. All three patients ultimately needed permanent nutritional support or experienced serious complications, showing that the procedure alone wasn’t enough to solve their long-term problems.

Previous research has shown that G-POEM can help some patients with stomach emptying problems when done the first time, especially for certain types of gastroparesis. However, there is very little information in medical literature about what happens when the procedure needs to be repeated. This study adds important information showing that repeating the procedure may not be as effective as the first time. The poor outcomes in this small group suggest that doctors should be cautious about recommending redo procedures and should explore other treatment options first.

This study has several important limitations: Only three patients were studied, which is too small a number to make general conclusions. The patients had different causes of their stomach problems, making it hard to know if results would be similar for other patients. The study looked backward at what already happened rather than following patients forward, which can miss important details. We don’t know if these three patients represent typical outcomes or if they were unusually unlucky. The study doesn’t compare outcomes to other treatment options, so we can’t say whether other approaches might work better. Finally, two of the three patients died, which makes it hard to fully understand long-term outcomes.

The Bottom Line

Based on this small study, doctors should be very cautious about recommending a second G-POEM procedure for patients whose symptoms return after the first one. Before considering a second procedure, patients and doctors should discuss other treatment options, such as different medications, dietary changes, or other surgical approaches. If a second procedure is being considered, patients should understand that it may not work as well as the first time and that long-term outcomes may not be good. This recommendation has low confidence because it’s based on only three patients.

This research is most important for people with gastroparesis (stomach emptying problems) who have already had a G-POEM procedure and are experiencing returning symptoms. It’s also important for their doctors who are deciding on next steps. People considering their first G-POEM procedure should know that if it doesn’t work well, repeating it may not be the answer. This doesn’t mean the first procedure is bad—it just means that if it doesn’t help enough, other options should be explored before trying it again.

In this study, patients’ symptoms returned or worsened within months to a year after the second procedure. However, because this is such a small study, individual experiences could vary. If you’re considering this procedure, you should discuss realistic timeframes with your doctor based on your specific situation.

Want to Apply This Research?

  • Track daily symptoms using a simple scale (1-10) for nausea, fullness after eating, and bloating. Also note what you ate and how much, since diet affects stomach emptying. This helps you and your doctor see if treatments are actually helping.
  • Work with a dietitian to follow a gastroparesis-friendly diet (small, frequent meals that are low in fat and fiber). Use the app to log meals and symptoms together to identify which foods make you feel worse. This can help you and your doctor decide if a procedure is really needed or if diet changes alone might help.
  • Set monthly check-ins to review your symptom trends and compare them to before any procedures. Track whether you’re able to eat more normally, maintain weight, and have fewer symptoms. Share this data with your doctor to help decide if treatments are working or if different approaches should be tried.

This study describes the experiences of only three patients and should not be used to make decisions about your own medical care. Gastroparesis is a serious condition that requires personalized treatment from a qualified gastroenterologist or surgeon. If you have stomach emptying problems or are considering any procedure, discuss all available treatment options, risks, and benefits with your healthcare provider. This research provides information about one specific procedure in a small group of patients and does not apply to everyone. Always consult with your doctor before making medical decisions.