POEM: Concept to Research Laboratory

Abstract

Given that the first experiments involving submucosal endoscopic esophageal myotomy in a porcine model were published in 2007, the interval uptake of peroral endoscopic myotomy (POEM) into clinical practice has been impressively swift. While the procedure remains limited to specialized practitioners and centers, it has become a valuable therapeutic option for the management of achalasia with outcomes that rival benchmarks established by more conventional surgical alternatives. Historical perspective helps to contextualize POEM as the conceptual outgrowth of a much longer therapeutic lineage rather than a de novo innovation to be added to the proceduralist’s armamentarium. Reflecting on the specific differences between submucosal endoscopic myotomy and the interventions (both experimental and established) that preceded it allows for a clearer understanding of the ways in which POEM represents a novel therapeutic paradigm, for spastic esophageal disorders in particular and for endoscopy in general. Looking ahead, distant milestones in this conceptual evolution might include technical elaboration made possible by novel endoscopic devices or, intriguingly, molecular therapies that might render endoscopic therapy for achalasia obsolete.