Peroral endoscopic myotomy for achalasia

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopy

Background:

• Achalasia is a rare esophageal motility disorder.
• Traditional treatments include Heller myotomy and pneumatic dilation.
• Peroral endoscopic myotomy (POEM) emerged as a novel endoscopic approach.

Purpose of the Study:

• To summarize the current status of POEM for achalasia.
• To compare POEM efficacy with traditional treatments like Heller myotomy (HM) and pneumatic dilation (PD).
• To discuss issues related to GERD after POEM and its management.

Main Methods:

• Review of technique variations in POEM.
• Comparative analysis of efficacy data for POEM versus HM and PD.
• Discussion of GERD assessment, management, and prevention strategies post-POEM.

Main Results:

• POEM is a well-validated, incisionless endoscopic treatment for esophageal achalasia.
• POEM demonstrates comparable or superior efficacy to laparoscopic Heller myotomy, particularly for type III achalasia.
• Gastroesophageal reflux disease (GERD) remains a significant concern requiring further investigation and management refinement.

Conclusions:

• POEM is an established and effective treatment for achalasia.
• Further refinements in POEM technique and post-procedural care are anticipated to address GERD.
• Comparative data supports POEM's role, especially for specific achalasia subtypes.