POEM: Pre-procedural Work-Up and Indications

  • Joseph Rayfield Triggs
  • John E. PandolfinoEmail author


Peroral endoscopic myotomy (POEM) is a transluminal endoscopic procedure which dissects the lower esophageal sphincter via access obtained through a submucosal tunnel. The procedure was first developed as a treatment for achalasia, but its indications have quickly spread. In addition to all the clinical subtypes of achalasia, its indications now include a subset of patients with esophagogastric junction outflow obstruction, distal esophageal spasm, jackhammer esophagus, and as retreatment following prior achalasia therapy. Current clinical practice suggests that the minimum work-up required prior to POEM should include upper endoscopy and high-resolution manometry. Here we review the growing body of literature regarding indications for POEM and the appropriate work-up including advanced diagnostic testing to identify those patients who are most likely to benefit from LES targeted therapy.


POEM High-resolution manometry HRM Achalasia EGJOO DES Jackhammer 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Section of Gastroenterology and Hepatology in the Department of MedicineNorthwestern Feinberg School of MedicineChicagoUSA
  2. 2.Division of Gastroenterology, Department of MedicineNorthwestern University’s Feinberg School of MedicineChicagoUSA

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