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, 22 (1), 14-24

Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders

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Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders

Young Hoon Youn et al. J Neurogastroenterol Motil.

Abstract

Peroral endoscopic myotomy (POEM) is the application of esophageal myotomy to the concept of natural orifice transluminal surgery (NOTES) by utilizing a submucosal tunneling method. Since the first case of POEM was performed for treating achalasia in Japan in 2008, this procedure is being more widely used by many skillful endosopists all over the world. Currently, POEM is a spotlighted, emerging treatment option for achalasia, and the indications for POEM are expanding to include long-standing, sigmoid shaped esophagus in achalasia, even previously failed endoscopic treatment or surgical myotomy, and other spastic esophageal motility disorders. Accumulating data about POEM demonstrate excellent short-term outcomes with minimal risk of major adverse events, and some existing long-term data show the efficacy of POEM to be long lasting. In this review article, we review the technical details and clinical outcomes of POEM, and discuss some considerations of POEM in special situations.

Keywords: Achalasia; Myotomy; Peroral endoscopic myotomy; Treatment.

Figures

Figure 1
Figure 1
Entry to the submucosal space. After submucosal injection of saline and 0.3% indigo carmine mixture, a 2-cm longitudinal mucosal incision is made at the mid esophagus.
Figure 2
Figure 2
Submucosal tunneling. A long submucosal tunnel is created 2–3 cm distal to the esophagogastric junction. The circular muscle fibers are perpendicular to the longitudinal direction of the tunnel.
Figure 3
Figure 3
Endoscopic myotomy of circular muscle bundle begins from 2–3 cm distal to the mucosal entry and extends to 2–3 cm distal to the esophagogastric junction. By using a triangle tip knife, endoscopic myotomy of inner circular muscle bundles is done, leaving the outer longitudinal muscle layer intact.
Figure 4
Figure 4
Closure of the mucosal entry. The mucosal incision of entry point is completely closed with hemostatic clips.

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