Peroral endoscopic myotomy (POEM) was first performed in 2008 as a novel treatment of achalasia. It is now performed globally, demonstrating the evolution of the first successful natural orifice transluminal endoscopic surgery (NOTES) procedure. There is extensive data demonstrating the safety and efficacy of POEM, and now long-term data has emerged demonstrating that the efficacy is durable. POEM is also being used to successfully treat diffuse esophageal spasm (DES) and jackhammer esophagus. With jackhammer esophagus and DES, inclusion of the lower esophageal sphincter in the myotomy minimizes the risk of symptom development from iatrogenic ineffective esophageal motility.
Key points
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Peroral endoscopic myotomy (POEM) is the first clinically successful natural orifice transluminal endoscopic surgery (NOTES) procedure that has achieved surgical efficacy with a safety profile comparable with endoscopic therapy.
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For the treatment of achalasia, there are now long-term data that demonstrate sustained clinical efficacy after POEM.
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POEM for diffuse esophageal spasm and hypercontractile esophagus should include the lower esophageal sphincter to prevent symptom development secondary to ineffective esophageal motility.
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The incidence of reflux after POEM is comparable with that after laparoscopic Heller myotomy.
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Infection-related adverse events with POEM have been rare, which should support further development of transesophageal mediastinal/peritoneal NOTES.
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