G-POEM: The Endoscopic Procedure for the Right Patients
G-POEM, short for gastric per-oral endoscopic myotomy and sometimes called POP (per-oral pyloromyotomy), is an incisionless procedure that cuts the pyloric muscle so the stomach can empty more freely. The pylorus is the muscular valve between the stomach and the small intestine. In many gastroparesis patients it fails to relax properly, so the stomach stays backed up. During G-POEM, a flexible endoscope is passed through the mouth, a small tunnel is created in the stomach lining, and the pyloric muscle is divided with an endoscopic knife. There are no abdominal incisions. It is done under general anesthesia, and most patients go home the same day.
Dr. Grandhige is one of only a handful of surgeons in the Tampa Bay area who perform G-POEM. It is a genuine therapeutic procedure, not a minor one, which is exactly why it belongs to patients whose gastroparesis has been confirmed by testing and has not responded to diet changes and medication, rather than being offered to everyone with stomach symptoms. The full step-by-step mechanics live on the gastroparesis treatment page so this page does not repeat them.
How G-POEM Compares to the Other Treatment Options
G-POEM is one option on a ladder that starts conservative and escalates only as needed. Most patients begin with diet: smaller and more frequent meals, well-cooked and low-fat foods, and limiting carbonation and alcohol, often with a dietitian’s help to keep calories and nutrition adequate. Medication is the next step. Promotility drugs such as metoclopramide (Reglan) and erythromycin speed the stomach up, though metoclopramide carries side-effect limits on long-term use and erythromycin tends to lose effect over time; domperidone has fewer side effects but is harder to access. Anti-nausea medications like ondansetron, prochlorperazine, and diphenhydramine control the nausea and vomiting rather than the emptying itself.
When symptoms persist despite diet and medication, procedures directed at the pylorus come into play. G-POEM is the endoscopic version. A robotic or laparoscopic pyloroplasty achieves a similar goal through small abdominal incisions and permanently widens the valve, which can occasionally cause looser stools or bile reflux because the stomach drains faster. For patients with severe weight loss and malnutrition who are too fragile for a definitive procedure, a feeding tube can restore nutrition first so a procedure can be considered safely later. In rare, severe cases unresponsive to everything else, removing most of the stomach is considered as a last resort.
A separate approach, gastric electrical stimulation with a surgically implanted device sometimes called a gastric pacemaker, suits a different subset of patients and is a device rather than a myotomy. Dr. Grandhige will tell you directly when another approach fits your situation better than G-POEM, and coordinates the referral when a device or a treatment he does not perform is the right answer. The goal of the consultation is the correct treatment, not a specific procedure.
Why a Foregut Surgeon Evaluates Gastroparesis Differently

Gastroparesis sits in the foregut, the connected system of the esophagus, stomach, and diaphragm, so a surgeon who works in that system every day reads it differently than a clinician who sees it occasionally. Dr. Gopal Grandhige has focused on foregut surgery in Tampa Bay since 2009, more than 16 years. He completed his general surgery residency and a fellowship in foregut and minimally invasive surgery at Yale New Haven Hospital, is a Founding Member of the American Foregut Society, a member of the Society of American Gastrointestinal and Endoscopic Surgeons, and a Fellow of the American College of Surgeons. You can read more about his training and background on the practice’s about the surgeon page.
That foregut focus matters because gastroparesis rarely travels alone. Its symptoms overlap with GERD, with silent reflux (LPR), with the motility disorder achalasia, and with the mechanical problem of a hiatal hernia, all of which are evaluated and treated in the same practice. Sorting out which condition is actually driving your symptoms is the first job, and it is easier for a surgeon who treats all of them.
Consistency in the operating room supports the outcomes. Dr. Grandhige performs all procedures at HCA Florida South Tampa Hospital with the same anesthesia team and the same dedicated physician assistant in every case, and that physician assistant, along with long-tenured office staff, stays reachable for your questions before and after the procedure rather than handing you to an unfamiliar provider.
Serving Clearwater and the Tampa Bay Area
Tampa Bay Reflux Institute is about a 30-minute drive from Clearwater, in the South Howard (SoHo) district of South Tampa. The office is at 1315 South Howard Avenue, Suite 101, in a yellow brick building next to Sally O’Neill’s Pizza, with parking behind the restaurant.
Access is built for people coming from Pinellas County. New patients are usually seen within two weeks, and always within four. Once a diagnosis is confirmed and a plan is set, most patients move from consultation to procedure within four to eight weeks, depending on whether testing is already done. For Clearwater and other out-of-town patients, the team arranges whatever testing can be done closer to home so a single trip across the bay does more work. Patients come from across Pinellas and the wider region, including St. Petersburg, Palm Harbor, Dunedin, Largo, and the surrounding communities.
Frequently Asked Questions
Take the Next Step
You do not have to keep cycling through medications that never quite work. If your gastroparesis symptoms have gone unexplained or untreated, an objective evaluation from a foregut surgeon can tell you what is actually happening and whether G-POEM is a fit for you. Tampa Bay Reflux Institute is a short drive from Clearwater.
An endoscopy cannot tell you if you have reflux. It can only tell you if you have complications of GERD.
If you are unhappy with your reflux symptoms, come in and we can discuss testing and treatments that can accurately diagnose your problem.
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CALL US AT 813-922-2920
www.tampareflux.com
If you have a hiatal hernia and fit one of these categories, you should know your options.
Dr. Grandhige is an expert in his field and performs 200 of these surgeries a year. He is the only surgeon in the Tampa Bay Area who offers all surgical options - LINX, Fundoplications, TIF and will be one of 20 surgeons in America introducing the latest procedure RefluxStop in 2026.
We accept most insurances but will verify yours before you come in. These procedures are considered medically necessary and covered by your insurance. You can expect to pay your in-network deductibles and nothing else.
#hiatalhernia #reflux #GERD #LINX #refluxstop
What causes reflux ?
1. Weak lower esophageal sphincter
2. Hiatal hernia
3. Flattening of the Angle of His
4. Poor esophageal motility
5. Gastroparesis (slow stomach)
NOT increased acid production
Don’t let GERD get in the way of living your life. Request your appointment with us today on the link below.
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https://tampareflux.com/contact-us/
Anyone can be victim to GERD and though weight loss can help reduce GERD symptoms. Many athletes with high impact workouts may continue to have these symptoms. This may be a symptom of a hiatal hernia or other issue. We are more then happy to assist you in finding your solution, just click the link below.
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https://tampareflux.com/contact-us/
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#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
#tampabayrefluxinstitute #guthealth #roboticsurgery
Heartburn may seem like an annoyance. But if you find yourself having symptoms on a daily basis, it may be time to to talk to Dr. Grandhige as it could be a symptom of something worse.
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#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
#tampabayrefluxinstitute #guthealth #roboticsurgery
If you are tired of avoiding your favorite foods or taking daily medications, we can help.
We are the Tampa experts in reflux ! With years of experience and thousands of patients treated successfully, we offer all FDA approved anti-reflux procedures.
Call 813-922-2920 to schedule your appointment
All major insurances accepted.
Not all patients need surgical intervention. Many patients are living a heartburn free life with their PPIs. However 40% of patients taking PPIs are not getting the relief they need. If you are one of those, you have options! Come in and find out more.
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#nonsurgicalweightloss #ESG #gastricballoon #weightlossjourney #vsg #vsgjourney #spatz3 #orbera #orberaballoon #grandhige #DrG
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