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World J Gastrointest Endosc. Oct 10, 2015; 7(14): 1129-1134
Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1129
Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia
Yalini Vigneswaran, Michael B Ujiki
Yalini Vigneswaran, Michael B Ujiki, Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University Health System, Evanston, IL 60201, United States
Yalini Vigneswaran, Michael B Ujiki, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
Author contributions: Vigneswaran Y contributed to the study idea, literature search, writing and final revision of the manuscript; Ujiki MB contributed to the writing and the final revision of the manuscript.
Conflict-of-interest statement: Dr. Yalini Vigneswaran and Dr. Michael B Ujiki have no conflicts of interest that are related to the work submitted here for publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael B Ujiki, MD, Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University Health System, 2650 Ridge Ave, Evanston, IL 60201, United States. mujiki@northshore.org
Telephone: +1-847-5701700 Fax: +1-847-5701330
Received: May 28, 2015
Peer-review started: May 31, 2015
First decision: August 18, 2015
Revised: August 25, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: October 10, 2015
Processing time: 143 Days and 21.8 Hours
Abstract

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure.

Keywords: Endoscopy; Achalasia; Peroral endoscopic myotomy; Myotomy

Core tip: With recent advancements in endoscopic techniques and technology, peroral endoscopic myotomy, also known as peroral endoscopic myotomy (POEM), has emerged as a promising minimally invasive procedure for treating achalasia. POEM uses the technique of endoscopic submucosal dissection to create a myotomy and palliate symptoms of achalasia. Although long-term outcomes are still needed, short-term outcomes show good safety and efficacy of the procedure that are comparable to laparoscopic Heller myotomy. In this review we will review the technical details of the procedure itself as well as the reported outcomes.