Peroral Endoscopic Myotomy (POEM)

A novel procedure, combining the efficiency of endoscopic access with the reliability of surgical myotomy, per-oral endoscopic myotomy (POEM) represents a paradigm shift in the management of idiopathic achalasia and other esophageal motor disorders. Comprehensive pre-operative evaluation by a multidisciplinary team of gastroenterologists and surgeons is essential to confirming candidacy for POEM and appropriately counseling patients on expected outcomes. The key steps of the procedure are detailed, including initial esophagogastroduodenoscopy (EGD), safe access to the submucosal space, creation of a submucosal tunnel extending at least 3 cm onto the gastric cardia, selective myotomy of the inner circular muscle fibers, and closure of the mucosotomy. Infrequently encountered complications include bleeding and inadvertent mucosotomy.