A Brief Insight about Peroral Endoscopic Myotomy (POEM)

Abstract

POEM is an innovative technique that has gained popularity as it is an effective and safe treatment modality in achalasia. During upper endoscopy under sedation, a mucosal incision is created in the middle to distal oesophagus, and the endoscope is advanced within the oesophageal submucosal layer using blunt dissection. Symptomatic patients with manometrically proven primary idiopathic achalasia are candidates for POEM. This is the acceptable alternative treatment for type I and II achalasia and the preferred treatment for type III achalasia. Relative contraindications to POEM procedure are severe erosive esophagitis, liver cirrhosis with portal hypertension and varices, significant coagulation disorders,or prior therapy (radiation, endoscopic mucosal resection or radiofrequency ablation). Previous intervention such as pneumatic balloon dilation, pharmacologic injection or surgical myotomy are not considered contraindications to POEM. POEM has an outstanding safety profile. The adverse events occurred only on 3.2% of procedures performed, with no mortality. The most common adverse outcomes were mucosal injury, pneumothorax, and barotraumas.