Delayed Intrathoracic Gastric Perforation after G-POEM for Treating Post-Operative Refractory Gastroparesis：A Case Report and Review of Literature

Background: Gastric peroral endoscopic pyloromyotomy(G-POEM) is introduced as a strategy to treat post-operative refractory gastroparesis. An intrathoracic gastric perforation is a rare complication of G-POEM. Case presentation: This report described the case of a patient who suffered with an intrathoracic gastric perforation about 10 days after a G-POEM procedure. A review of the PUBMED literature indexed in English with the key words of perforation and G-POEM was performed and the results were considered. The results indicated that delayed perforation was a rare complication after G-POEM. Overeating may cause the severe intrathoracic gastric dilation and perforation. Furthermore, successful nonsurgical management after G-POEM complicated by delayed perforation could be a highly feasible option, if intensive conservative treatments were used. Conclusions: Delayed perforation after G-POEM treating post-operative refractory can lead to severe mediastinal and thoracic infections. Fully prepared before the G-POEM procedure and effective suture instrument during the procedure may reduce the incidence of perforations. If perforation occurs after G-POEM, conservative treatment can be chosen if a patient’s general situation allows. However, the choice of surgical treatment must not be ignored if the patient's overall condition deteriorates.