title: Per-oral endoscopic myotomy: major advance in achalasia treatment and in endoscopic surgery.
abstract: Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.
authors.affiliation: David Friedel, Rani Modayil, Stavros N Stavropoulos, Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, NY 11501, United States.
authors.forename: David
authors.initials: D
authors.lastname: Friedel
authors.affiliation: David Friedel, Rani Modayil, Stavros N Stavropoulos, Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, NY 11501, United States.
authors.forename: Rani
authors.initials: R
authors.lastname: Modayil
authors.affiliation: David Friedel, Rani Modayil, Stavros N Stavropoulos, Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, NY 11501, United States.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
mesh_terms: D004931:Esophageal Achalasia / Q000175:diagnosis / Q000266:history / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D009055:Mouth; D009130:Muscle, Smooth / Q000503:physiopathology / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000266:history / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Achalasia; EndoFLIP; Endoscopic myotomy; Endoscopic submucosal dissection; Endoscopic suturing; Natural orifice transluminal endoscopic surgery; Per oral endoscopic myotomy; Submucosal tunnel endoscopic resection; Submucosal tunnel endoscopy