Clinical Endoscopy

Original Articles

Anterior versus posterior peroral endoscopic myotomy: a prospective randomized controlled trial from a Thai tertiary center: Tharathorn Suwatthanarak, Siwaree Maneesoi, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Somchai Leelakusolvong, Chainarong Phalanusitthepa; Received October 31, 2025 Accepted February 9, 2026 Published online August 13, 2026; DOI: https://doi.org/10.5946/ce.2025.407 [Epub ahead of print]

Graphical Abstract Abstract PDF: Background
/Aims: Achalasia is an esophageal motility disorder. Peroral endoscopic myotomy is widely used for all subtypes; however, randomized head-to-head evidence comparing the anterior and posterior approaches remains limited. We compared efficacy, safety, and reflux outcomes.
Methods
We conducted a single-center, single-blind, prospective randomized controlled trial from February 2023 to August 2024. Twenty-eight patients with achalasia types I–III were randomized to anterior or posterior peroral endoscopic myotomy. The primary outcomes were esophageal acid exposure at 3 months (24-hour pH monitoring) and clinical success (Eckardt score ≤3). The secondary outcomes were procedural parameters, complications, timed barium esophagography, manometry, and reflux esophagitis.
Results
Baseline characteristics were comparable between the groups. Procedural metrics and complication rates were similar and mild, with no severe adverse events. At 12 months, both groups showed significant symptom relief, reduced Eckardt scores, and decreased lower esophageal sphincter pressure. Posterior myotomy yielded a higher proportion of abnormal DeMeester scores (57.1% vs. 28.6%, p=0.14), although reflux esophagitis remained mild and comparable between the groups.
Conclusions
Posterior peroral endoscopic myotomy demonstrated comparable efficacy, safety, and reflux outcomes. The anterior approach improved clearance on timed barium esophagography; however, both approaches achieved durable symptom control with acceptable safety profiles, supporting posterior myotomy as a valid alternative.

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Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand: Tharathorn Suwatthanarak, Chainarong Phalanusitthepa, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Thikhamporn Tawantanakorn, Somchai Leelakusolvong, Monthira Maneerattanaporn, Piyaporn Apisarnthanarak, Jitladda Wasinrat; Clin Endosc 2024;57(5):610-619. Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.236

Graphical Abstract Abstract PDF

Background
/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM.
Methods
This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up.
Results
Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017).
Conclusions
These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

Citations

Citations to this article as recorded by

Assessment and Management of Reflux‐Related Esophageal Stricture After Peroral Endoscopic Myotomy in Achalasia
Shao‐Bin Luo, Zu‐Qiang Liu, Li Wang, Ming‐Yan Cai, Quan‐Lin Li, Ping‐Hong Zhou, Wei‐Feng Chen
Journal of Gastroenterology and Hepatology.2026; 41(1): 248. CrossRef
Pressure‐flow analysis following peroral endoscopic myotomy in pediatric achalasia: Novel insights into esophageal emptying
Renato Tambucci, Giulia Chiarazzo, Nathalie Rommel, Chiara Imondi, Tamara Caldaro, Paola De Angelis, Valerio Balassone
Journal of Pediatric Gastroenterology and Nutrition.2026; 83(1): 159. CrossRef
Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy
Tae Hee Lee
Clinical Endoscopy.2024; 57(5): 604. CrossRef

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Case Report

Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review: Sz-Iuan Shiu; Clin Endosc 2021;54(2):275-279. Published online January 15, 2021; DOI: https://doi.org/10.5946/ce.2020.093

Abstract PDF Supplementary Material: Esophageal diverticula (ED) represents a group of rare conditions that warrant intervention when they are symptomatic or coexisting with pulmonary disorders. Few literature reviews have described this patient entity or discussed the postoperative outcome. Therefore, I present the case of a 59-year-old woman with symptoms of dysphagia who was significantly underweight, which was conducive to the diagnosis of symptomatic ED. Because she was a poor candidate for surgery, she received a diverticular peroral endoscopic myotomy. She subsequently developed parapneumonic effusion and tension pneumothorax after the procedure. She was finally discharged on postoperative day 23. I also performed the first known comprehensive literature review of 34 published cases (including my patient) from PubMed and have addressed the demography, intervention, and prognosis for symptomatic ED after the procedure. Prompt treatment as well as prognostic measurement are crucial to successful outcomes.

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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy

Peroral Endoscopic Myotomy for Esophageal Motility Disorders: Jun Young Kim, Yang Won Min; Clin Endosc 2020;53(6):638-645. Published online November 20, 2020; DOI: https://doi.org/10.5946/ce.2020.223

Abstract PDF

Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.

Citations

Citations to this article as recorded by

Endoskopische Therapie von Ösophagusmotilitätsstörungen
Sandra Nagl
Die Gastroenterologie.2026; 21(3): 178. CrossRef
Intraoperative Complications During Benign Esophageal Surgery
Katelyn R. Ward, Jenny Bui, Rishindra M. Reddy
Thoracic Surgery Clinics.2025; 35(3): 329. CrossRef
Evaluation of Anesthesia Management During Peroral Endoscopic Myotomy in Patients with Achalasia: A Retrospective Study
Mukadder Sanli, Sami Akbulut, Muharrem Ucar, Yilmaz Bilgic
Journal of Clinical Medicine.2025; 14(18): 6504. CrossRef
Peroral endoscopic myotomy as an effective and safe treatment for achalasia: The authors’ experience and a literature review
Wojciech Ciesielski, Tomasz Klimczak, Izabela Kempska, Martyna Waszczyk, Aleksandra Osielczak, Adam Durczyński, Janusz Strzelczyk, Jarosław Buczyński, Piotr Hogendorf
International Journal of Gastrointestinal Intervention.2025; 14(4): 197. CrossRef
Diffuse Esophageal Spasm: An Alternative Treatment Approach
McKenzie K Allen , Wayne Frei
Cureus.2024;[Epub] CrossRef
Imaging following endoscopic and surgical treatment of achalasia
Kristina T. Flicek, Laura R. Carucci, Mary Ann Turner
Abdominal Radiology.2024; 50(5): 1942. CrossRef
Diagnostics and Treatment of Esophageal Achalasia (Clinical Guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, REndO Endoscopi
V. T. Ivashkin, A. S. Trukhmanov, I. V. Maev, O. M. Drapkina, A. I. Martynov, O. A. Storonova, E. A. Godgello, M. P. Korolev, T. L. Lapina, P. V. Pavlov, A. V. Paraskevova, I. A. Tarasova, E. D. Fedorov, A. T. Tskhovrebov, M. P. Shapka, A. L. Shestakov, A
Russian Journal of Gastroenterology, Hepatology, Coloproctology.2024; 34(6): 120. CrossRef
Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia
Lena Shally, Kashif Saeed, Derek Berglund, Mark Dudash, Katie Frank, Vladan N. Obradovic, Anthony T. Petrick, David L. Diehl, Jon D. Gabrielsen, David M. Parker
Surgical Endoscopy.2023; 37(7): 5526. CrossRef
Benefit of extending the protocol for high resolution manometry according to the version 4.0 of the Chicago criteria. A multicenter study
Luis G. Alcalá‐González, Alberto Ezquerra‐Duran, Ariadna Aguilar, Claudia Barber, Elizabeth Barba, Isis K. Araujo, Ingrid Marin, Juan Naves, Jordi Serra
Neurogastroenterology & Motility.2023;[Epub] CrossRef
Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract
Jin Hee Noh, Hwoon-Yong Jung
Journal of Neurogastroenterology and Motility.2023; 29(1): 7. CrossRef
Surveillance Endoscopy After Foregut Surgery: Is It Necessary?
Yahya Alwatari, Daniel Scheese, Graham Gardner, Vignesh Vudatha, Walker Julliard, Carlos Puig Gilbert, Rachit D. Shah
Foregut: The Journal of the American Foregut Society.2023; 3(1): 89. CrossRef
Per oral endoscopic myotomy for achalasia: A Taiwanese single‐center experience
Yu‐Chi Lee, Wei‐Chen Tai, Keng‐Liang Wu, Chih‐Chien Yao, Seng‐Kee Chuah
Advances in Digestive Medicine.2022; 9(4): 241. CrossRef
Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management
Fabio Sbaraglia, Pietro Familiari, Federica Maiellare, Marco Mecarello, Annamaria Scarano, Demetrio Del Prete, Rosa Lamacchia, Federica Antonicelli, Marco Rossi
Journal of Anesthesia, Analgesia and Critical Care.2022;[Epub] CrossRef
A rare complication: Tension pneumothorax after peroral endoscopic myotomy
Seokin Kang, Yuri Kim, Do Hoon Kim
International Journal of Gastrointestinal Intervention.2022; 11(3): 139. CrossRef
Endoscopic Management of Dysphagia
Min Ji Kim, Yang Won Min
The Korean Journal of Gastroenterology.2021; 77(2): 77. CrossRef
An update on endoscopic treatment for achalasia: From per oral endoscopic myotomy to endolumenal functional lumen imaging probe
Wei‐Chen Tai, Keng‐Liang Wu, Seng‐Kee Chuah
Advances in Digestive Medicine.2021; 8(1): 8. CrossRef

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Original Article

Determining the Safety and Effectiveness of Electrocautery Enhanced Scissors for Peroral Endoscopic Myotomy (with Video): Kelly E. Hathorn, Walter W. Chan, Hiroyuki Aihara, Christopher C. Thompson; Clin Endosc 2020;53(4):443-451. Published online May 22, 2020; DOI: https://doi.org/10.5946/ce.2019.214

Abstract PDF Supplementary Material

Background
/Aims: Peroral endoscopic myotomy (POEM) has recently come to the forefront in the management of achalasia. We aimed to analyze the efficacy and safety of the use of electrocautery enhanced scissors (EES) for POEM.
Methods
This retrospective cohort study prospectively collected the data of all adult patients (aged ≥18 years) with normal foregut anatomy who underwent POEM using EES. The patients’ baseline characteristics and procedure details (time, tunnel length, myotomy length, depth, and location) were recorded. The primary outcome was clinical success (3-month post-procedure Eckardt score of ≤3). The secondary outcomes were technical success and adverse events. A paired Student’s t-test was performed.
Results
Fifteen patients were included in this study. The technical success rate of myotomy using EES was 100%. Fellows participated in the myotomy in all cases. The clinical success rate was 93.3% (14/15). The mean pre-Eckardt score was 5.4±2.5, while the mean post-Eckardt score was 1.3±1.3, which indicated a significant improvement (p≤0.0001). The most common treatment-related adverse events were post-procedure pain (4, 26.7%) and symptomatic reflux disease (4, 26.7%).
Conclusions
In the largest series to date on the use of EES in POEM, we demonstrated that this technique has both technical and clinical efficacy as well as an excellent safety profile.

Citations

Citations to this article as recorded by

Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
David J. Tate, Enrique Rodriguez de Santiago, Michele Montori, Vikash Lala, Lynn K. Debels, Eduardo Albéniz, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Alanna Ebigbo, Pietro Familiari, Paul Fockens, Henriette Heinrich, Oleksandr Kiosov, Helmut
Endoscopy.2025; 57(08): 912. CrossRef
Peroral endoscopic myotomy using an endoscopic dissector: another novel device in our toolbox
Shruti Mony, Apurva Shrigiriwar, Andrew Canakis, Mouen A. Khashab
VideoGIE.2023; 8(1): 5. CrossRef
Peroral endoscopic myotomy (POEM) is more cost-effective than laparoscopic Heller myotomy in the short term for achalasia: economic evaluation from a randomized controlled trial
Tatiana Morgado Conte, Luciana Bertocco de Paiva Haddad, Igor Braga Ribeiro, Eduardo Turiani Hourneaux de Moura, Luiz Augusto Carneiro DʼAlbuquerque, Eduardo Guimarães Hourneaux de Moura
Endoscopy International Open.2020; 08(11): E1673. CrossRef

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Case Report

Hybrid Peroral Endoscopic Myotomy for Achalasia with Prior Treatment Failure: In Kyung Yoo, Abdullah OzgurYeniova, Joo Young Cho; Clin Endosc 2021;54(1):127-130. Published online April 2, 2020; DOI: https://doi.org/10.5946/ce.2020.013

Abstract PDF Supplementary Material: Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroral endoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect the outcome of POEM as they cause submucosal fibrosis. We report a new technique called “hybrid POEM” for the treatment of patients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques of POEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part of the esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcame submucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks of mucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.

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Original Article

Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center: Maen Masadeh, Peter Nau, Subhash Chandra, Jagpal Klair, John Keech, Kalpaj Parekh, Rami El Abiad, Henning Gerke; Clin Endosc 2020;53(3):321-327. Published online November 20, 2019; DOI: https://doi.org/10.5946/ce.2019.110

Abstract PDF

Background
/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions.
Methods
This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3.
Results
A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve.
Conclusions
POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions.

Citations

Citations to this article as recorded by

Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis
Han Zhang, Xinxin Pu, Shu Huang, Huifang Xia, Kang Zou, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, Xiaowei Tang
Diseases of the Esophagus.2024;[Epub] CrossRef
Surgical and per-oral endoscopic myotomy (POEM) for the treatment of primary esophageal motility disorders: A systematic analysis of current trends in Germany between 2011 and 2019
Jennis Kandler, Tobias Essing, David Schöler, Georg Flügen, Wolfram T. Knoefel, Christoph Roderburg, Tom Luedde, Sven H. Loosen, Dong Keon Yon
PLOS ONE.2024; 19(1): e0297265. CrossRef
Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
Endoscopy.2023; 55(04): 355. CrossRef
Management of the patient with esophagogastric junction outflow obstruction
Dariush Shahsavari, Zubair Malik, Henry P. Parkman
Current Opinion in Gastroenterology.2021; 37(4): 397. CrossRef
Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
Zaheer Nabi, Radhika Chavan, Mohan Ramchandani, Jahangeer Basha, Nitin Jagtap, Arun Karyampudi, Santosh Darisetty, Manu Tandan, Rajesh Goud, Guduru Venkat Rao, Duvvur Nageshwar Reddy
Journal of Clinical Gastroenterology.2021; 55(7): 594. CrossRef
Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience
S Bomman, J S Klair, M Ashat, R El Abiad, H Gerke, J Keech, K Parekh, P Nau, Y Hanada, L M Wong Kee Song, R Kozarek, S Irani, D Low, A Ross, R Krishnamoorthi
Diseases of the Esophagus.2021;[Epub] CrossRef
Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification
Mario Costantini, Renato Salvador, Andrea Costantini
Foregut: The Journal of the American Foregut Society.2021; 1(3): 254. CrossRef
Non-achalasia esophageal motility disorders: Role of per-oral endoscopic myotomy
Zaheer Nabi, Duvuur Nageshwar Reddy
International Journal of Gastrointestinal Intervention.2020; 9(2): 67. CrossRef
Peroral Endoscopic Myotomy, a Well-Established, Efficacious, and Safe Treatment Option for Achalasia: Is the History of Previous Treatment a Hurdle or Not?
Young Hoon Youn
Clinical Endoscopy.2020; 53(3): 247. CrossRef

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Case Report

Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: Hak Su Kim, Hee Kyung Kim, Weon Jin Ko; Clin Endosc 2020;53(2):232-235. Published online July 16, 2019; DOI: https://doi.org/10.5946/ce.2019.067

Abstract PDF Supplementary Material

Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtype achalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.

Citations

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Multiple submucosal tunneling endoscopic myotomies to address angulation in advanced sigmoid-type achalasia
Jing-Zheng Liu, Li-Na Fan, Ping-Hong Zhou
Gastroenterology Report.2026;[Epub] CrossRef
Endoskopische Therapie von Ösophagusmotilitätsstörungen
Sandra Nagl
Die Gastroenterologie.2026; 21(3): 178. CrossRef
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Ahmad Abbas, Mohammad Jaradat, Hidaya Kmail, Sameer Nairat, Razan Haj, Firas Jallad, Osama Qudaih, Jaser Amro, Baraa Diab, Mohanad Nazzal
Clinical Case Reports.2026;[Epub] CrossRef

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Review

Anesthetic Consideration for Peroral Endoscopic Myotomy: Yun-Sic Bang, Chunghyun Park; Clin Endosc 2019;52(6):549-555. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.033

Abstract PDF

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

Citations

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Tension pneumoperitoneum combined with CO2 gas embolism during peroral endoscopic myotomy: a case report and review of literature
Shui Yu, Xiaofeng Hu, Jingyan Xu, Qin Wang, Jingxiong Zhang, Kai Sun, Xiaoxia Zhou
Frontiers in Medicine.2026;[Epub] CrossRef
Advances and challenges in peroral endoscopic myotomy: Safety, precision, and post-procedure management
Grigorios Christodoulidis, Kyriaki Tsagkidou, Konstantinos Eleftherios Koumarelas, Marina Nektaria Kouliou
World Journal of Gastroenterology.2025;[Epub] CrossRef
Factors predicting insufflation-related events in peroral endoscopic myotomy procedures
Feng-Pai Tsai, Chien-Chuan Chen, Min-Hsiu Liao, Hsiu-Po Wang, Ming-Shiang Wu, Jia-Feng Wu, Shou-Zen Fan, Ping-Huei Tseng
Journal of Gastrointestinal Surgery.2025; 29(4): 101988. CrossRef
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Ahmed Tawheed, Alaa Ismail, Ahmed El-Tawansy, Karim Maurice, Ahmed Ali, Amr El-Fouly, Ahmad Madkour
World Journal of Methodology.2025;[Epub] CrossRef
Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
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Focused Review Series: The New Eras of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Current Status of Peroral Endoscopic Myotomy: Young Kwan Cho, Seong Hwan Kim; Clin Endosc 2018;51(1):13-18. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.165

Abstract PDF

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Citations

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Introduction to Endoscopic Submucosal Surgery: Weon Jin Ko, Joo Young Cho; Clin Endosc 2018;51(1):8-12. Published online January 23, 2018; DOI: https://doi.org/10.5946/ce.2017.154

Abstract PDF

The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.

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Case Report

Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM: Hee Jin Hong, Ga Won Song, Weon Jin Ko, Won Hee Kim, Ki Baik Hahm, Sung Pyo Hong, Joo Young Cho; Clin Endosc 2016;49(4):383-386. Published online March 15, 2016; DOI: https://doi.org/10.5946/ce.2015.108

Abstract PDF

With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.

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Review

Peroral Endoscopic Myotomy: Establishing a New Program: Nikhil A. Kumta, Shivani Mehta, Prashant Kedia, Kristen Weaver, Reem Z. Sharaiha, Norio Fukami, Hitomi Minami, Fernando Casas, Monica Gaidhane, Arnon Lambroza, Michel Kahaleh; Clin Endosc 2014;47(5):389-397. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.389

Abstract PDF

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.

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Original Article

Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study: Byung Hoo Lee, Kwang Yeun Shim, Su Jin Hong, Gene Hyun Bok, Jun-Hyung Cho, Tae Hee Lee, Joo Young Cho; Clin Endosc 2013;46(2):161-167. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.161

Abstract PDF

Background/Aims

Achalasia is a rare esophageal motility disorder. Recently, a novel endoscopic technique, peroral endoscopic myotomy (POEM), was introduced as an alternative treatment for achalasia. We report the results and short term outcomes of POEM for patients with achalasia.

Methods

POEM was performed in 13 patients with achalasia. The procedure consisted of creating a submucosal tunnel followed by endoscopic myotomy of circular muscle bundles. The mucosal entry was closed by conventional hemostatic clips. A validated clinical symptom score (Eckardt score) and high resolution manometry were used to evaluate the outcomes.

Results

Both the clinical score of achalasia, as well as the resting lower esophageal sphincter (LES) pressure, were significantly reduced after POEM. Mean posttreatment Eckardt score was 0.4±0.7, compared to 6.4±1.9 prior to the treatment (p=0.001). The mean pretreatment and posttreatment LES pressure was 30.3 and 15.3 mm Hg, respectively (p=0.007). Following POEM, symptomatic relief from dysphagia without reflux symptoms was observed in all patients (13/13). No serious complications related to POEM were encountered.

Conclusions

Based upon our initial experience, the authors believe that POEM is a feasible, safe, and effective treatment and may possibly substitute established treatments of refractory achalasia.

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Pietro Familiari, Giovanni Gigante, Michele Marchese, Ivo Boskoski, Andrea Tringali, Vincenzo Perri, Guido Costamagna
Annals of Surgery.2016; 263(1): 82. CrossRef
Surgery or Peroral Esophageal Myotomy for Achalasia
Luigi Marano, Giovanni Pallabazzer, Biagio Solito, Stefano Santi, Alessio Pigazzi, Raffaele De Luca, Francesco Giuseppe Biondo, Alessandro Spaziani, Maurizio Longaroni, Natale Di Martino, Virginia Boccardi, Alberto Patriti
Medicine.2016; 95(10): e3001. CrossRef
Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy
Davinderbir Pannu, Dennis Yang, Patricia L. Abbitt, Peter V. Draganov
Gastrointestinal Endoscopy.2016; 84(3): 408. CrossRef
Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years
Yuki B Werner, Guido Costamagna, Lee L Swanström, Daniel von Renteln, Pietro Familiari, Ahmed M Sharata, Tania Noder, Guido Schachschal, Jan F Kersten, Thomas Rösch
Gut.2016; 65(6): 899. CrossRef
Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM
Hee Jin Hong, Ga Won Song, Weon Jin Ko, Won Hee Kim, Ki Baik Hahm, Sung Pyo Hong, Joo Young Cho
Clinical Endoscopy.2016; 49(4): 383. CrossRef
Achalasia: from diagnosis to management
Michael F. Vaezi, Valter N. Felix, Roberto Penagini, Aurelio Mauro, Eduardo Guimarães Hourneaux de Moura, Leonardo Zorrón Cheng Tao Pu, Jan Martínek, Erwin Rieder
Annals of the New York Academy of Sciences.2016; 1381(1): 34. CrossRef
Complications of submucosal endoscopy
Jean-Michel Gonzalez, Alban Benezech, Marc Barthet
Best Practice & Research Clinical Gastroenterology.2016; 30(5): 783. CrossRef
Update on the endoscopic treatments for achalasia
Dushant S Uppal, Andrew Y Wang
World Journal of Gastroenterology.2016; 22(39): 8670. CrossRef
Gestion des complications de l’endoscopie interventionnelle œsophagienne
C. Lorenceau-Savale, G. Rahmi
Acta Endoscopica.2015; 45(3): 90. CrossRef
Greater curvature myotomy is a safe and effective modified technique in per-oral endoscopic myotomy (with videos)
Manabu Onimaru, Haruhiro Inoue, Haruo Ikeda, Chiaki Sato, Hiroki Sato, Chainarong Phalanusitthepha, Esperanza Grace Santi, Kevin L. Grimes, Hiroaki Ito, Shin-ei Kudo
Gastrointestinal Endoscopy.2015; 81(6): 1370. CrossRef
Peroral Esophageal Myotomy Versus Laparoscopic Heller's Myotomy for Achalasia: A Meta-analysis
Mingtian Wei, Tinghan Yang, Xuyang Yang, Ziqiang Wang, Zongguang Zhou
Journal of Laparoendoscopic & Advanced Surgical Techniques.2015; 25(2): 123. CrossRef
Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis
Rupjyoti Talukdar, Haruhiro Inoue, D. Nageshwar Reddy
Surgical Endoscopy.2015; 29(11): 3030. CrossRef
Is Peroral Endoscopic Myotomy Effective for the Treatment of Spastic Esophageal Disorders Refractory to Medical Therapy?
Jae Pil Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(2): 143. CrossRef
The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on peroral endoscopic myotomy
Vinay Chandrasekhara, David Desilets, Gary W. Falk, Haruhiro Inoue, John R. Romanelli, Thomas J. Savides, Stavros N. Stavropoulos, Lee L. Swanstrom
Gastrointestinal Endoscopy.2015; 81(5): 1087. CrossRef
Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders
Young Hoon Youn, Hitomi Minami, Philip Wai Yan Chiu, Hyojin Park
Journal of Neurogastroenterology and Motility.2015; 22(1): 14. CrossRef
Effect of Peroral Endoscopic Myotomy on Esoph ageal Motor Function
Su Jin Hong
Journal of Neurogastroenterology and Motility.2015; 22(1): 1. CrossRef
Achalasia: current treatment options
Pietro Familiari, Santi Greco, Ance Volkanovska, Giovanni Gigante, Anna Cali, Ivo Boškoski, Guido Costamagna
Expert Review of Gastroenterology & Hepatology.2015; 9(8): 1101. CrossRef
Systematic review and meta‐analysis: Efficacy and safety of POEM for achalasia
Lavinia A Barbieri, Cesare Hassan, Riccardo Rosati, Uberto Fumagalli Romario, Loredana Correale, Alessandro Repici
United European Gastroenterology Journal.2015; 3(4): 325. CrossRef
Per-oral endoscopic myotomy white paper summary
Stavros N. Stavropoulos, David J. Desilets, Karl-Hermann Fuchs, Christopher J. Gostout, Gregory Haber, Haruhiro Inoue, Michael L. Kochman, Rani Modayil, Thomas Savides, Daniel J. Scott, Lee L. Swanstrom, Melina C. Vassiliou
Surgical Endoscopy.2014; 28(7): 2005. CrossRef
Peroral endoscopic myotomy for achalasia
A. J. Bredenoord, T. Rösch, P. Fockens
Neurogastroenterology & Motility.2014; 26(1): 3. CrossRef
Peroral Endoscopic Myotomy: Establishing a New Program
Nikhil A. Kumta, Shivani Mehta, Prashant Kedia, Kristen Weaver, Reem Z. Sharaiha, Norio Fukami, Hitomi Minami, Fernando Casas, Monica Gaidhane, Arnon Lambroza, Michel Kahaleh
Clinical Endoscopy.2014; 47(5): 389. CrossRef
Introduction of the per-oral endoscopic myotomy technique to pediatric surgical practice
Stephanie Chao, Michael Russo, Robert Wright, Homero Rivas, James Wall
Journal of Pediatric Surgery Case Reports.2014; 2(6): 313. CrossRef
International Digestive Endoscopy Network 2014: Turnpike to the Future
Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
Clinical Endoscopy.2014; 47(5): 371. CrossRef
Per-oral endoscopic myotomy white paper summary
Stavros N. Stavropoulos, David J. Desilets, Karl-Hermann Fuchs, Christopher J. Gostout, Gregory Haber, Haruhiro Inoue, Michael L. Kochman, Rani Modayil, Thomas Savides, Daniel J. Scott, Lee L. Swanstrom, Melina C. Vassiliou
Gastrointestinal Endoscopy.2014; 80(1): 1. CrossRef
Effectiveness of peroral endoscopic myotomy in the treatment of achalasia: A pilot trial in Chinese Han population with a minimum of one‐year follow‐up
Ting Sheng Ling, Hui Min Guo, Tian Yang, Chun Yan Peng, Xiao Ping Zou, Rui Hua Shi
Journal of Digestive Diseases.2014; 15(7): 352. CrossRef
Jackhammer Esophagus Treated by a Peroral Endoscopic Myotomy
Weon Jin Ko, Byoung Moo Lee, Won Young Park, Jin Nyoung Kim, Jun-Hyung Cho, Tae Hee Lee, Su Jin Hong, Joo Young Cho
The Korean Journal of Gastroenterology.2014; 64(6): 370. CrossRef
Effect of peroral endoscopic myotomy in achalasia patients with failure of prior pneumatic dilation: A prospective case–control study
Tingsheng Ling, Huimin Guo, Xiaoping Zou
Journal of Gastroenterology and Hepatology.2014; 29(8): 1609. CrossRef
Medical and Endoscopic Management of Achalasia
Jae Pil Han, Su Jin Hong
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(2): 82. CrossRef
EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy
Pietro Familiari, Giovanni Gigante, Michele Marchese, Ivo Boskoski, Vincenzo Bove, Andrea Tringali, Vincenzo Perri, Graziano Onder, Guido Costamagna
United European Gastroenterology Journal.2014; 2(2): 77. CrossRef
Per Oral Endoscopic Myotomy (POEM): Review of Current Techniques and Outcomes (Including Postoperative Reflux)
David Friedel, Rani Modayil, Stavros N. Stavropoulos
Current Surgery Reports.2013; 1(4): 203. CrossRef
Peroral Endoscopic Myotomy for the Treatment of Achalasia: An Analysis
Dennis Yang, Mihir S. Wagh
Diagnostic and Therapeutic Endoscopy.2013; 2013: 1. CrossRef
Therapeutic flexible endoscopy replacing surgery: Part 3—Peroral esophageal myotomy
Ezra N. Teitelbaum, Eric S. Hungness
Techniques in Gastrointestinal Endoscopy.2013; 15(4): 211. CrossRef
Highlights of International Digestive Endoscopy Network 2013
Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
Clinical Endoscopy.2013; 46(5): 425. CrossRef
Perorale endoskopische Myotomie zur Therapie der Achalasie
B.H.A. von Rahden, J. Filser, S. Reimer, H. Inoue, C.-T. Germer
Der Chirurg.2013;[Epub] CrossRef

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