POEM for Achalasia.

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery

Background:

• Esophageal achalasia is a motility disorder characterized by dysphagia and regurgitation.
• Traditional treatments include pneumatic dilation, botulinum toxin injection, and laparoscopic Heller myotomy.
• Peroral endoscopic myotomy (POEM) emerged in 2008 as a novel endoscopic approach.

Purpose of the Study:

• To evaluate the efficacy and safety of POEM for esophageal achalasia.
• To compare POEM with existing treatment modalities.
• To identify potential complications and long-term outcomes of POEM.

Main Methods:

• POEM involves endoscopic transection of esophageal and lower esophageal sphincter muscle fibers.
• The procedure is performed without an external incision, similar to laparoscopic Heller myotomy without fundoplication.
• Short-term studies have assessed symptom relief and procedural outcomes.

Main Results:

• POEM has demonstrated high short-term effectiveness in alleviating dysphagia and regurgitation.
• The procedure is technically feasible and can be performed by trained endoscopists.
• Concerns exist regarding the incidence of post-POEM gastroesophageal reflux.

Conclusions:

• POEM is a promising minimally invasive treatment for esophageal achalasia with good short-term results.
• Long-term data, particularly on reflux incidence, are crucial for establishing its definitive role.
• Prospective and randomized trials are necessary to determine the optimal place of POEM in achalasia management.