Indian Journal of Surgery

, Volume 81, Issue 5, pp 452–456 | Cite as

POEM for Treatment of Achalasia: Our Early Experience and Technical Details of the Procedure

  • Pravin R. SuryawanshiEmail author
  • Ashok R. Mohite
Original Article


Achalasia cardia is a rare disease characterized by incomplete relaxation of the lower esophageal sphincter (LES) and nonperistaltic esophagus leading to symptoms of dysphagia and chest pain. The traditional treatment options include endoscopic balloon dilation, Heller’s myotomy and botulinum toxin injection. Per Oral Endoscopic Myotomy (POEM) is a new treatment option for achalasia cardia based on concept of natural orifice transluminal endoscopic surgery (NOTES). There are important ethical considerations regarding training in POEM, which is a novel procedure falling between NOTES and advanced endoscopic intervention. Experienced endoscopist with good endoscope manipulation skills can perform this technically demanding procedure. Twenty-four POEM procedures are performed by single operator who had experience in advanced laparoscopy and therapeutic endoscopy including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in tertiary care endoscopy center. Except one patient who had mucosal injury during submucosal tunnel creation which was clipped and procedure was completed, all other procedures were uncomplicated. At 6-month follow-up, 100% of patients had relief of symptoms (Eckardt scores; Pre POEM 9.70 vs post-POEM 0.66) and 60% reduction in IRP on esophageal manometry. One third of patient experienced symptomatic gastroesophageal reflux disease (GERD) which is easily managed by medication. POEM is a safe and effective treatment for the management of achalasia cardia. In recent future, it will be the preferred option in achalasia cardia treatment as the long-term data will be available and more number of endoscopist will master this technically demanding procedure.


Achalasia cardia Minimally invasive surgery Per oral endoscopic myotomy (POEM) Natural orifice transluminal endoscopic surgery (NOTES) 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Wang YR, Dempsey DT, Friedenberg FK, Richter JE (2008) Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993–2005: effect of surgery volume on perioperative outcomes. Am J Gastroenterol 103:1–11Google Scholar
  2. 2.
    Patti MG, Fisichella PM (2014 Sep) Controversies in management of achalasia. J Gastrointest Surg 18(9):1705–1709CrossRefGoogle Scholar
  3. 3.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60(1):114–117CrossRefGoogle Scholar
  4. 4.
    Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton P, Hawes R, Kalloo A, Kantsevoy S, Gostout C (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39:761–764CrossRefGoogle Scholar
  5. 5.
    Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefGoogle Scholar
  6. 6.
    Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342CrossRefGoogle Scholar
  7. 7.
    Inoue H, Santi EG, Onimaru M, Kudo SE (2014) Submucosal endoscopy: from ESD to POEM and beyond. Gastrointest Endosc Clin N Am 24(2):257–264CrossRefGoogle Scholar
  8. 8.
    Friedel D, Modayil R, Iqbal S, Grendell JH, Stavropoulos SN (2013) Per-oral endoscopic myotomy for achalasia: an American perspective. World J Gastrointest Endosc. 5(9):420–427CrossRefGoogle Scholar
  9. 9.
    NOSCAR POEM White Paper Committee, Stavropoulos SN, Desilets DJ, Fuchs KH, Gostout CJ, Haber G, Inoue H et al (2014) Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc 80(1):1–15CrossRefGoogle Scholar
  10. 10.
    Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Maselli R, Santi G (2016) Submucosal tunnel endoscopy: peroral endoscopic myotomy and peroral endoscopic tumor resection. World J Gastrointest Endosc 8(2):86–103CrossRefGoogle Scholar
  11. 11.
    Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB et al (2015) Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 3(3):E195–E201CrossRefGoogle Scholar
  12. 12.
    Kumta NA, Mehta S, Kedia P, Weaver K, Sharaiha RZ, Fukami N, Minami H, Casas F, Gaidhane M, Lambroza A, Kahaleh M (2014) Peroral endoscopic myotomy: establishing a new program. Clin Endosc 47(5):389–397CrossRefGoogle Scholar
  13. 13.
    Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rösch T (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65(6):899–906CrossRefGoogle Scholar
  14. 14.
    Kumagai K, Tsai JA, Thorell A, Lundell L, Håkanson B (2015) Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy? Scand J Gastroenterol 50(5):505–512CrossRefGoogle Scholar
  15. 15.
    Li QL, Chen WF, Zhou PH, Yao LQ, Xu MD, Hu JW, Cai MY, Zhang YQ, Qin WZ, Ren Z (2013) Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy. J Am Coll Surg 217(3):442–451CrossRefGoogle Scholar
  16. 16.
    Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L (2012) Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 26(11):3267–3272CrossRefGoogle Scholar
  17. 17.
    Li C, Gong A, Zhang J, Duan Z, Ge L, Xia N et al (2017) Clinical outcomes and safety of partial full-thickness myotomy versus circular muscle myotomy in peroral endoscopic myotomy for achalasia patients. Gastroenterol Res Pract 2017:2676513PubMedPubMedCentralGoogle Scholar
  18. 18.
    Zhou PH, Cai MY, Yao LQ, Zhong YS, Ren Z, Xu MD, Chen WF, Qin XY (2011) Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases. Zhonghua Wei Chang Wai Ke Za Zhi 14(9):705–708PubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.Department of SurgeryMahatma Gandhi Mission Medical College and HospitalAurangabadIndia
  2. 2.Department of GastroenterologyMahatma Gandhi Mission Medical College and HospitalAurangabadIndia

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