title: Peroral endoscopic myotomy: establishing a new program.
abstract: 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.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Weaver
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Minami
authors.affiliation: Gastroenterología y Endoscopia Digestiva, Hospital Central de la Policía Nacional, Bogota, Colombia.
authors.forename: Fernando
authors.initials: F
authors.lastname: Casas
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Arnon
authors.initials: A
authors.lastname: Lambroza
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
keywords: Achalasia; Myotomy; Natural orifice endoscopic surgery; Peroral endoscopic myotomy; Therapeutics