Any input on botox or G-POEM (Gastric Peroral Endoscopic Myotomy)?

Hi Judy... we talk on our twice-weekly EC and Esophagectomy Zoom calls quite often. I'm hopeful some G-POEM patients pop on here to tell you of their QofLife situations afterwards. I still look at your situation as follows:

Cholecystectomy (gallbladder removal) alters bile dynamics by removing the storage organ, causing a continuous, unregulated trickle of bile into the small intestine. However, after an esophagectomy, reflux severity and amount are primarily driven by the absence of the lower esophageal sphincter and the loss of natural anti-reflux barriers, rather than just pyloric function.For severe, medically refractory poor motility post-esophagectomy, the G-POEM (Gastric Per-Oral Endoscopic Myotomy) procedure is frequently recommended to facilitate gastric emptying. By permanently cutting the pylorus muscle, it relieves outflow obstruction.However, performing a G-POEM in a patient who has already undergone an esophagectomy inherently increases the risk of bile reflux. Opening the pyloric valve removes the body's natural barrier against duodenal contents moving backwards. Because the LES (Lower Esophageal Sphincter) was previously removed during the esophagectomy, any bile that refluxes into the stomach can travel very easily up into the esophagus or conduit, potentially causing more severe and frequent reflux symptoms.When deciding on a G-POEM, clinicians must weigh the need to resolve severe, life-impacting gastric stasis against the increased risk of postoperative bile reflux.

Thnx Gary. I’m continuing research. Today the hospital wouldn’t do my solid food test because they said I needed to withhold ppi and other gerd meds for a full 48 hours! The previous time tested I was not asked to withhold those meds.
Trying to get to Fred Hutch for assistance. Fred Hutch would be easier than Mayo but really at this point I’m willing to go anywhere to try to get some help. I just need someone to guide me through the gastroparesus as the Virginia Mason route seems to be not functioning.

@juneau1062, how are you doing with the decision-making? Are things improving with stretching and botox?

Coleen Young - Thank you. I’m home in Alaska now. The second day after Botox I experienced a big bile reflux while sleeping. Ended up in ER but lungs seem to have cleared now. This always knocks you down. Flew home and last two nights okay. Slowly increasing food so time will tell. My experience at VM has deteriorated seriously since the departure of Dr. Hubka, my Surgeon. It has been almost impossible to communicate with anyone. My thoracic navigator was fabulous but now it’s not possible to talk with anyone in the GI section. Licensing in Alaska is the issue. I can’t have a telemedicine because they aren’t licensed! I’m exploring finding another care provider. I don’t know how I would handle this situation without this support group. The members have literally saved me and continue to help each time I attend. It’s such a journey and hard to explain to people. Participants know what you are experiencing and have offered great advice. Here in Juneau we have no GI or oncology services so I will always need to travel. My Gp doctor is great and will help in any way if needed but she shares that this is all new for the practice so they can support but are honest that they have no specific knowledge in this area. She feels I need someone familiar with the gastroporesus and whole esophageal cancer journey. I’m considering Fred Hutch or Mayo but need to start the process. It’s of course daunting.
I’m concerned Gpoem might result in more bile reflux so am hesitant to proceed that way without more input so I wanted the Botox first. Maybe my lack of gall bladder is the issue.
It’s a journey but I am lucky. I was 1b as it was discovered accidentally during a routine colonoscopy and endoscopy to get to duodenum! Straight to surgery!
Thank you again for this group. It’s helping me cope.

I had a g- poem procedure for severe gastroparesis post esophagectomy. Curiously the Botox option was never offered to me. Unfortunately for me, I sustained the rare complication of a duodenal perforation. Having gotten through that, I do feel that the procedure helped with my eating challenges ( coughing, hiccuping, burping, vomiting) . I am able to eat more at a time. I have been struggling with some dumping issues. I do have occasional bile acid reflux including one episode that caused some frightening stridor. Best not to eat within 2 hours of bedtime and always sleep on an incline. Despite the unfortunate complication, I do feel that it was worth it.