VA Resident Report: What is the effectiveness of POEM for achalasia?

Available data suggests POEM is very effective in the relief of symptoms in patients with achalasia. However, POEM is associated with a very high incidence of pathologic reflux. The clinical sequalae of the increase in pathologic reflux are currently incompletely understood, but it is plausible that longer-term outcomes associated with POEM may demonstrate GERD complications such as stricture and/or Barrett esophagus

Shlottmann, F., Luckett, D., Fine, J., Shaheen, N., & Patti, M. (n.d.). Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis. Annals of Surgery., Annals of surgery. , 2017.

Esophageal achalasia is characterized by lack of peristalsis and by a lower esophageal sphincter (LES) which fails to relax appropriately in response to swallowing. Treatment is not curative, but aims to eliminate the outflow resistance caused by the nonrelaxing LES.  In 2010, Inoue et al54 described the results of a new endoscopic technique called per oral endoscopic myotomy (POEM) in 17 patients with esophageal achalasia. They described the endoscopic creation of a submucosal tunnel, which allowed a myotomy by the transection of the circular fibers of the distal esophagus.

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