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POEM in the Treatment of Esophageal Disorders

Current Treatment Options in Gastroenterology volume 16, pages 27–40 (2018)Cite this article

Opinion statement

Purpose of the review

Peroral endoscopic myotomy (POEM) is a novel minimally invasive technique that has emerged as the preferred option for the treatment of achalasia and spastic esophageal disorders (SED) at many centers around the world. In this article, we review and summarize the recent literature on POEM in patients with achalasia and SED. The current article is largely focused on the new developments and findings, extended applications, and long-term outcomes of POEM in patients with achalasia and SED.

Recent findings

POEM is a safe and effective therapy for patients with achalasia and SED. POEM is comparable to Heller myotomy (HM) in terms of safety, efficacy, and complications, including gastroesophageal reflux disease (GERD). Outcomes of POEM are excellent even in patients who had prior failed therapies for achalasia, including failed HM and prior POEM. Recent data also suggest the efficacy and safety of POEM in both pediatric and geriatric patients. GERD after POEM is common, and the majority of patients are asymptomatic. The management, goals of therapy, and long-term outcomes of GERD after POEM are unclear. Objective testing for all patients is recommended.

Summary

POEM is a validated treatment for all patients with achalasia and SED. Candidates should be carefully selected and appropriately counseled on expected outcomes and the need for long-term surveillance.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance ••Of major importance

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Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Building, Suite 7125B, Baltimore, MD, 21287, USA

    Nasim Parsa MD & Mouen A. Khashab MD

  2. Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, MD, USA

    Nasim Parsa MD

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Nasim Parsa declares no conflict of interest.

Mouen A. Khashab is a consultant for Boston Scientific and Olympus America. He also serves on the medical advisory board of Boston Scientific and Olympus America.

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Parsa, N., Khashab, M.A. POEM in the Treatment of Esophageal Disorders. Curr Treat Options Gastro 16, 27–40 (2018). https://doi.org/10.1007/s11938-018-0168-0

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Keywords

  • POEM
  • Peroral endoscopic myotomy
  • Achalasia
  • Esophageal motility disorders
  • Heller myotomy
  • Outcomes