title: Per oral endoscopic myotomy for the treatment of achalasia.
abstract: Per oral endoscopic myotomy (POEM) represents the culmination of natural orifice transluminal endoscopic surgery (NOTES) research, and its most successful application to date. Over a thousand POEMs have been performed globally with remarkable results in terms of clinical efficacy and safety.
  
  
  OBJECTIVE
  We examine the most recent literature concerning POEM since the last two comprehensive analyses [Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) White Paper, ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI)], and integrate this literature in the consensus POEM guidelines and perspective. These current works are largely centered on POEM operator learning curve, comparison of POEM and laparoscopic Heller myotomy (LHM) and extended application of POEM.
  
  
  RESULTS
  POEM and LHM are comparable in terms of efficacy (diminished dysphagia and Eckardt score) and complications including GERD. POEM has been successfully performed in a wide variety of patients including children, those with prior achalasia therapy and those with spastic esophageal disorders.
  
  
  CONCLUSIONS
  POEM has been validated as a treatment for achalasia. Issues remain regarding its longer term efficacy in comparison with LHM. Subsequent comparison trials are needed.
  http://links.lww.com/COG/A14.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
authors.forename: Rani
authors.initials: R
authors.lastname: Modayil
authors.forename: David
authors.initials: D
authors.lastname: Friedel
mesh_terms: D004931:Esophageal Achalasia / Q000473:pathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome