Published online Jan 25, 2016. doi: 10.4253/wjge.v8.i2.86
Peer-review started: April 24, 2015
First decision: July 22, 2015
Revised: October 19, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: January 25, 2016
Peroral endoscopic myotomy (POEM) is an innovative, minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy (LHM), not only for all types of esophageal achalasia [classical (I), vigorous (II), spastic (III), Chicago Classification], but also for advanced sigmoid type achalasia (S1 and S2), failed LHM, or other esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). POEM starts with a mucosal incision, followed by submucosal tunnel creation crossing the esophagogastric junction (EGJ) and myotomy. Finally the mucosal entry is closed with endoscopic clip placement. POEM permitted relatively free choice of myotomy length and localization. Although it is technically demanding procedure, POEM can be performed safely and achieves very good control of dysphagia and chest pain. Gastroesophageal reflux is the most common troublesome side effect, and is well controllable with proton pump inhibitors. Furthermore, POEM opened the era of submucosal tunnel endoscopy, with many other applications. Based on the same principles with POEM, in combination with new technological developments, such as endoscopic suturing, peroral endoscopic tumor resection (POET), is safely and effectively applied for challenging submucosal esophageal, EGJ and gastric cardia tumors (submucosal tumors), emerged from muscularis propria. POET showed up to know promising results, however, it is restricted to specialized centers. The present article reviews the recent data of POEM and POET and discussed controversial issues that need further study and future perspectives.
Core tip: Submucosal tunnel endoscopy: Peroral endoscopic myotomy (POEM) and peroral endoscopic tumor resection (POET), constitutes a novel terrain for miniinvasive endoscopic treatment of diseases, where the surgical alternatives are totally incomparable, particularly in elderly. POEM showed exciting results in international level in treating all types of achalasia [classical (I), vigorous (II), spastic (III)], including advanced sigmoid type, failed surgical or laparoscopic Heller myotomy cases, and other esophageal motility disorders (diffuse esophageal spasm, nutcracker and jackhammer esophagus). POET was spawned from the success of POEM, and slowly expanded worldwide to treat muscularis based esophageal, esophagogastric junction and cardia submucosal tumors. Submucosal tunnel endoscopy further inspired other applications and opened promising future perspectives.