Introduction: Endoscopic Submucosal Dissection to Per Oral Endoscopic Myotomy (POEM)
The development of peroral endoscopic myotomy (POEM) for esophageal achalasia is, in large part, the result of large-population screening for GI malignancy. While screening for colorectal cancer in average risk patients over the age of 50 is well accepted in America, there is no equivalent screening protocol to address esophageal or gastric cancer. In Japan, on the other hand, the rates of both gastric adenocarcinoma and squamous carcinoma of the esophagus are much higher than those observed in Western countries. As a result, screening upper endoscopy is not only more widespread, but also more sophisticated, involving adjuncts such as chromoendoscopy, narrow band imaging, magnification endoscopy, and more recently endocytoscopy. A large number of lesions are detected (the National Cancer Center in Tokyo alone treats more than 10,000 gastric lesions per year), and some form of resection is recommended for the vast majority. Based on the observation that early lesions have a very low rate of lymph node metastasis, local resection is often preferable to surgery, and a number of endoscopic techniques have evolved for this purpose.
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