Clin Endosc.  2014 Sep;47(5):389-397. 10.5946/ce.2014.47.5.389.

Peroral Endoscopic Myotomy: Establishing a New Program

• Kumta NA
• Mehta S
• Kedia P
• Weaver K
• Sharaiha R
• Fukami N
• Minami H
• Casas F
• Gaidhane M
• Lambroza A
• Kahaleh M

• KMID: 2165368
• DOI: http://doi.org/10.5946/ce.2014.47.5.389

Abstract

Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.

Keyword

Peroral endoscopic myotomy; Achalasia; Myotomy; Therapeutics; Natural orifice endoscopic surgery

MeSH Terms

Esophageal Achalasia
Esophageal Motility Disorders
Esophageal Sphincter, Lower
Esophagogastric Junction
Humans
Natural Orifice Endoscopic Surgery
Relaxation

Figure

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  Fig. 1 Room setup for conducting peroral endoscopic myotomy.

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  Fig. 2 Anterior view of the tunnel during peroral endoscopic myotomy.

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  Fig. 3 Posterior view of the tunnel during peroral endoscopic myotomy.

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  Fig. 4 Tunnel closure with hemoclips.

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  Fig. 5 Tunnel closure with endoscopic sutures.

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