Esophageal POEM: the new standard of care

Abstract

Since its introduction into clinical practice nearly a decade ago, per-oral endoscopic myotomy (POEM) has now become an accepted minimally invasive approach for the treatment of achalasia with excellent short-and mid-term clinical outcomes in both treatment naïve and those who have failed prior therapy. POEM is comparable to laparoscopic Heller myotomy (LHM) in terms of efficacy and safety, with less procedural pain and faster recovery time. Recent data also reveals that POEM may be more effective and durable than pneumatic dilation (PD) for the treatment of achalasia, with similar safety profile. Preliminary data on POEM for spastic esophageal disorders (SED) is promising yet scarce. Post-POEM gastroesophageal reflux disease (GERD) is common but asymptomatic in most patients, further highlighting the need for ongoing research in this field and the importance of long-term surveillance of these patients.

Modified protocol for Enhanced Recovery After Surgery is beneficial for achalasia patients undergoing peroral endoscopic myotomy: a randomized prospective trial.

“…For achalasia patients undergoing POEM, fasting for a longer time is widely accepted. Several studies have adopted a clear liquid diet for more than 48 h prior to the procedure, and nil per os (NPO) after midnight on the day of the procedure [ 14 , 15 ]. In our study, we allowed patients to take a low fiber and low residue diet until 6 h before surgery and water until 2 h before surgery.…”

POEM Controversies: State of the Art and Science

“…Conversely, with a posterior approach, the POEM is initiated on the posterolateral wall of the esophagus (5-to 6-o'clock position) instead. 7,8 When initially introduced by Dr. Inoue, the POEM procedure was performed using anterior approach based on anatomical considerations. An anterior myotomy reduces the risk of injury to the angle of His and the sling muscle fibers located over the greater curvature, which play an important role in the natural anti-reflux mechanism.…”

“…7 For patients with type 3 achalasia, POEM has been considered the preferred approach over LHM, as the former allows a manometry driven tailored longer esophageal myotomy. 8-10…”

“…Conversely, with a posterior approach, the POEM is initiated on the posterolateral wall of the esophagus (5- to 6-o’clock position) instead. 7,8…”

Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship

“…Per-oral endoscopic myotomy (POEM) is an established endoscopic technique for treatment of achalasia and other selected esophageal motility disorders [1][2][3], with recent high-quality studies supporting its efficacy and safety when performed by expert endoscopists [4,5]. In spite of the increasing adoption of this technique worldwide, data on training for POEM remain relatively scarce.…”