Skip to main content
SpringerLink
Log in
Book cover

Foregut Surgery pp 37–46Cite as

Per-oral Endoscopic Myotomy

  • Chapter
  • First Online:

  • 635 Accesses

Abstract

Per-oral endoscopic myotomy is an accepted procedure for the treatment of achalasia. Pre-procedure workup should include upper endoscopy, esophagram, and high-resolution manometry. The procedure is performed in the submucosal space using specialized endoscopic submucosal dissection tools. Submucosal tunneling and selective myotomy of the lower esophageal sphincter circular muscle are key components of the procedure. Common complications include minor bleeding and capno-peritoneum. There are robust short- and moderate-term outcomes data showing procedural safety as well as excellent relief of symptoms compared to laparoscopic Heller myotomy. Emerging long-term literature supports the effectiveness and durability of this procedure.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

EGD:

esophagogastroduodenoscopy

EGJ:

esophagogastric junction

ESD:

endoscopic submucosal dissection

GERD:

gastroesophageal reflux disease

HRM:

high-resolution manometry

POEM:

per-oral endoscopic myotomy

TBE:

time barium esophagram

References

  1. Teitelbaum EN, Swanstrom LL. Submucosal surgery: novel interventions in the third space. Lancet Gastroenterol Hepatol. 2018;3(2):134–40.

    Article  PubMed  Google Scholar 

  2. Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy. 2007;39(9):761–4.

    Article  CAS  PubMed  Google Scholar 

  3. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.

    Article  CAS  PubMed  Google Scholar 

  4. Goldblum JRWR, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol. 1994;4(18):327–37.

    Article  Google Scholar 

  5. Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):e256–61.

    Article  CAS  PubMed  Google Scholar 

  6. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313(18):1841–52.

    Article  PubMed  Google Scholar 

  7. Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65(5):732–9.

    Article  PubMed  Google Scholar 

  8. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807–16.

    Article  CAS  PubMed  Google Scholar 

  9. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230(4):587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Zaninotto G, Costantini M, Molena D, Portale G, Costantino M, Nicoletti L, et al. Minimally invasive surgery for esophageal achalasia. JLaparoendoscAdv Surg Tech. 2001;11(6):351–9.

    Article  CAS  Google Scholar 

  11. Eckardt VF. Clinical presentation and complications of achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):281–92.

    Article  CAS  PubMed  Google Scholar 

  12. Taft TH, Carlson DA, Triggs J, Craft J, Starkey K, Yadlapati R, et al. Evaluating the reliability and construct validity of the Eckardt symptom score as a measure of achalasia severity. Neurogastroenterol Motil. 2018;30(6):e13287.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJPM. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography1. NeurogastroenterolMotil. 2012;24(s1):57–65.

    Article  Google Scholar 

  14. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. NeurogastroenterolMotil. 2014;27(2):160–74.

    Article  Google Scholar 

  15. Kachala SS, Rice TW, Baker ME, Rajeswaran J, Thota PN, Murthy SC, et al. Value of routine timed barium esophagram follow-up in achalasia after myotomy. J Thorac Cardiovasc Surg. 2018;156:871.

    Article  PubMed  Google Scholar 

  16. Stavropoulos SN, Modayil RJ, Friedel D, Savides T. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc. 2013;27(9):3322–38.

    Article  PubMed  Google Scholar 

  17. Teitelbaum EN, Soper NJ, Arafat FO, Santos BF, Kahrilas PJ, Pandolfino JE, et al. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg. 2014;18(1):92–9.

    Article  PubMed  Google Scholar 

  18. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(03):E195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718–25.

    Article  PubMed  Google Scholar 

  20. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ. Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264(3):508–17.

    Article  PubMed  Google Scholar 

  21. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77(5):719–25.

    Article  PubMed  Google Scholar 

  22. Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg. 2011;213(6):751–6.

    Article  PubMed  Google Scholar 

  23. Hungness ES, Jorge JM. Per-oral esophageal myotomy: is it a safe and durable procedure for achalasia? Adv Surg. 2017;51(1):193–205.

    Article  PubMed  Google Scholar 

  24. Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg. 2013;17(2):228–35.

    Article  PubMed  Google Scholar 

  25. von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, et al. Peroral endoscopic myotomy for the treatment of achalasia: aprospective single center study. Am J Gastroenterol. 2011;107:411.

    Article  Google Scholar 

  26. Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145(2):309–11.e3.

    Article  Google Scholar 

  27. El Khoury R, Teitelbaum EN, Sternbach JM, Soper NJ, Harmath CB, Pandolfino JE, et al. Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM). Surg Endosc. 2016;30(7):2969–74.

    Article  PubMed  Google Scholar 

  28. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221(2):256–64.

    Article  PubMed  Google Scholar 

  29. Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut. 2016;65(6):899–906.

    Article  CAS  PubMed  Google Scholar 

  30. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259(6):1098–103.

    Article  PubMed  Google Scholar 

  31. Crespin OM, Liu LWC, Parmar A, Jackson TD, Hamid J, Shlomovitz E, et al. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc. 2017;31(5):2187–201.

    Article  PubMed  Google Scholar 

  32. Barbieri LA, Hassan C, Rosati R, Romario UF, Correale L, Repici A. Systematic review and meta-analysis: efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3(4):325–34.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Marano L, Pallabazzer G, Solito B, Santi S, Pigazzi A, De Luca R, et al. Surgery or peroral esophageal myotomy for achalasia: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(10):e3001.

    Article  Google Scholar 

  34. Talukdar R, Inoue H, Reddy DN. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc. 2015;29(11):3030–46.

    Article  PubMed  Google Scholar 

  35. Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Wille AJ, Reavis KM, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19(1):161–70; discussion 70.

    Article  PubMed  Google Scholar 

  36. Ward MA, Gitelis M, Patel L, Vigneswaran Y, Carbray J, Ujiki MB. Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM). Surg Endosc. 2017;31(4):1550–7.

    Article  PubMed  Google Scholar 

  37. Teitelbaum EN, Soper NJ, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc. 2014;28(12):3359–65.

    Article  PubMed  Google Scholar 

  38. von Renteln D, Inoue H, Minami H, Werner YB, Pace A, Kersten JF, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107(3):411–7.

    Article  Google Scholar 

  39. Chen X, Li Q-p, Ji G-z, Ge X-x, Zhang X-h, X-y Z, et al. Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy. Eur J Cardiothorac Surg. 2015;47(5):890–6.

    Article  PubMed  Google Scholar 

  40. Teitelbaum EN, Dunst CM, Reavis KM, Sharata AM, Ward MA, DeMeester SR, et al. Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc. 2018;32(1):421–7.

    Article  PubMed  Google Scholar 

  41. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256(4):659–67.

    Article  PubMed  Google Scholar 

  42. Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis. 2012;44(10):827–32.

    Article  PubMed  Google Scholar 

  43. Rohof WO, Hirsch DP, Kessing BF, Boeckxstaens GE. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology. 2012;143(2):328–35.

    Article  PubMed  Google Scholar 

  44. Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48(12):1059–68.

    Article  PubMed  Google Scholar 

  45. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26(1):18–26.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Amy L. Holmstrom & Eric S. Hungness

Authors
  1. Amy L. Holmstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric S. Hungness
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric S. Hungness .

Editor information

Editors and Affiliations

  1. University of North Carolina, Chapel Hill, NC, USA

    Marco G. Patti

  2. University of North Carolina, Chapel Hill, NC, USA

    Marco Di Corpo

  3. University of Buenos Aires, Buenos Aires, Argentina

    Francisco Schlottmann

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Holmstrom, A.L., Hungness, E.S. (2020). Per-oral Endoscopic Myotomy. In: Patti, M., Di Corpo, M., Schlottmann, F. (eds) Foregut Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-27592-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-27592-1_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-27591-4

  • Online ISBN: 978-3-030-27592-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation