The treatment of achalasia is centered on reducing the resting tone of the lower esophageal sphincter, so that ingested material may pass into the stomach unimpeded.
Multiple treatment modalities have been implemented to accomplish this goal, however the surgical myotomy (Heller) where the longitudinal and circular muscle fibers are divided with sparing the esophageal mucosa has produced the most promising long-term results. In an effort to minimize or eliminate incisions altogether, there has been a strong interest in conducting this myotomy using an endoscopic approach. Recently, the peroral endoscopic myotomy (POEM) has been described in which the circular muscle of the lower esophageal sphincter is divided, while the longitudinal muscle layer is left intact. Early data is promising and suggests that POEM has the potential to provide the efficacy of surgery with the cost and morbidity of a pure endoscopic procedure.
KeywordsEsophageal achalasia Peroral endoscopic myotomy (POEM) Natural orifice transluminal endoscopic surgery (NOTES) Upper endoscopy Esophageal manometry Barium swallow Gastroesophageal reflux disease (GERD) Dysphagia Portland esophagotomy criteria
Conflict of Interest
The authors have no conflict of interest.
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