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POEM is performed safely and effectively in a wide range of patients, including pediatric patients and the elderly. In addition to classic achalasia, POEM is performed in cases of spastic esophageal motility disorders, advanced sigmoid achalasia, or following prior endoscopic or surgical treatment.
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Clinical results are excellent in short- and long-term follow-up and seem to be comparable or better than surgical myotomy.
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The technical points presented aid in the safe completion of the procedure
Per Oral Endoscopic Myotomy for Achalasia: A Detailed Description of the Technique and Review of the Literature
Section snippets
Key points
Diagnosis
Definitive diagnosis of achalasia is made by demonstrating an integrated relaxation pressure of 15 mm Hg or greater on high-resolution esophageal manometry, which has a sensitivity of 97%.2 High-resolution esophageal manometry can differentiate three subtypes of achalasia, and identify other esophageal motility disorders that may respond to POEM (Table 1).3
Barium esophagram may demonstrate a classic “bird’s beak” taper at the esophagogastric junction (EGJ) and is useful in identifying dilation,
Short-Term Outcomes (<2 Years)
Numerous studies, including two meta-analyses of more than 1000 patients each, have demonstrated the short-term success of POEM in reducing Eckardt scores and LES pressures.13, 45 Most centers report more than 90% clinical success rate, with a few rare exceptions, the lowest still being good at 82.4%.46 Similar results are seen after prior surgical or endoscopic therapies; in pediatric patients; and in patients with spastic esophageal disorders, such as diffuse esophageal spasm or jackhammer
Potential complications and management
Overall complication rates vary widely among centers and studies because of heterogeneity in definitions and reporting. Pooled analyses demonstrate adverse event rates that are similar to LHM.13, 45
Summary
POEM is a safe and effective technique for the treatment of achalasia and spastic esophageal motility disorders, with excellent results in short- and long-term follow-up. The procedure has been successfully performed in children as young as 3 years, and in the elderly. Further studies are needed to establish the optimal length and location of the myotomy to ensure relief of dysphagia while minimizing the risk of post-POEM reflux. Ongoing randomized trials comparing POEM with LHM may ultimately
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Cited by (29)
Achalasia: Diagnosis, Management and Surveillance
2021, Gastroenterology Clinics of North AmericaCitation Excerpt :POEM involves the endoscopic creation of a submucosal tunnel and selective myotomy of the esophagus and proximal stomach. The typical length of myotomy is 8 to 12 cm.56 A longer myotomy may be helpful in patients with type III achalasia in order to treat the entire spastic segment of esophagus as determined by manometry.
Per-Oral Endoscopic Myotomy (POEM) for Achalasia: Techniques, Outcomes and Clinical Applications
2021, Surgery Open Digestive AdvancePrinciples of Intramural Surgery
2020, Surgical Clinics of North AmericaCitation Excerpt :Of those, 116 (6.4%) were mild, 31 (1.7%) were moderate, and only 9 (0.5%) were severe. Complications in intramural surgery include pneumoperitoneum, pneumothorax, pneumomediastinum, hemorrhage, and perforation.17 Clinically significant pneumoperitoneum can be decompressed with 20-gauge needle in the abdomen, and pneumothorax should be decompressed with needle thoracostomy—with or without subsequent tube placement based on the clinical scenario.
A History of Flexible Gastrointestinal Endoscopy
2020, Surgical Clinics of North AmericaResponse
2020, Gastrointestinal EndoscopyPer oral endoscopic myotomy: Another tool in the toolbox
2019, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :However, this quickly evened out to 50:50 within 1 year of performing our first POEM procedure. All POEM procedures were performed under general anesthesia with CO2 insufflation in an operating room, using standard steps as described by Grimes and Inoue.9 We used our previously published 2-person technique in every case.10