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Achalasia pp 45-50 | Cite as

Peroral Endoscopic Myotomy

  • Marc A. Ward
  • Michael B. Ujiki

Abstract

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.

Keywords

Esophageal 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 

Notes

Conflict of Interest

The authors have no conflict of interest.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Chicago Pritzker School of MedicineChicagoUSA
  2. 2.Department of Surgery, Section of Minimally Invasive SurgeryNorthshore University HealthsystemEvanstonUSA

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