Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1129
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
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.
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.