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Peroral Endoscopic Myotomy (POEM) for Achalasia: Indications, Techniques, and Outcomes

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

POEM represents a novel endoscopic version of Heller myotomy, the time-honored gold standard for achalasia therapy. POEM represents the first successful realization of the NOTES (Natural Orifice Transluminal Endoscopy Surgery) ideal, namely, the minimally invasive “scarless” performance of intrathoracic or intraabdominal surgeries via natural body orifices rather than surgical incisions. This chapter provides an in-depth comprehensive review of POEM with an emphasis on current controversies and areas of intense investigation. Topics to be covered include the broad range of POEM indications in diverse patient populations and conditions extending from achalasia to nonachalasia esophageal motility disorders, POEM technique variations and adjuncts, mid and long term efficacy outcomes, adverse events, and comparative data versus other standard therapies including detailed analysis of reflux after POEM relative to other achalasia treatments. We will address in particular the data that refute the misconception that reflux is much more prevalent after POEM than after Heller myotomy.

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Authors and Affiliations

  1. Mount Sinai St Luke’s West Hospital Center, New York City, NY, USA

    Xiaocen Zhang

  2. NYU-Winthrop Hospital, Mineola, NY, USA

    Rani Modayil

  3. Program in Advanced GI Endoscopy (P.A.G.E.), NYU-Winthrop Hospital, Mineola, NY, USA

    Stavros N. Stavropoulos

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  1. Xiaocen Zhang
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  3. Stavros N. Stavropoulos
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  1. Division of Gastroenterology and Gastrointestinal Endoscopy IRCCS, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA

    Michael B. Wallace

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  1. Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

    Michael B. Wallace

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Zhang, X., Modayil, R., Stavropoulos, S.N. (2022). Peroral Endoscopic Myotomy (POEM) for Achalasia: Indications, Techniques, and Outcomes. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-56993-8_33

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