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Per-oral Endoscopic Myotomy (POEM) for Non-achalasia Disorders

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NOTES and Endoluminal Surgery

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Per-oral endoscopic myotomy (POEM) is a novel endoscopic procedure, which has been performed to treat achalasia with favorable outcomes. Emerging data suggest that POEM may also have a role in the treatment of patients with spastic esophageal disorders (SEDs). SEDs include spastic or type III achalasia, distal esophageal spasm (DES), and hypercontractile (Jackhammer) esophagus. Despite the difference in pathophysiology, these disorders share many similarities, including their clinical manifestations. Patients may present with one or all of the following symptoms: dysphagia, non-cardiac chest pain, regurgitation, and refractory gastroesophageal reflux symptoms. The gold standard to diagnose these disorders is high-resolution esophageal manometry. While medical therapy fails in the majority of these patients, surgical myotomy is invasive and associated with suboptimal results due to the need for long esophageal myotomy. POEM provides an ideal therapy for SEDs, as it allows for long esophageal myotomy in addition to myotomy of the lower esophageal sphincter (LES). Emerging data suggest POEM is both effective and safe for treating patients with SEDs. Similarly, gastric POEM (G-POEM) or endoscopic pyloromyotomy is a novel procedure for the treatment of patients with gastroparesis refractory to medical therapy. Emerging data suggest promising outcomes. Prospective multicenter data on POEM for SEDs and G-POEM for gastroparesis are awaited.

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Abbreviations

CI:

Contractile integral

DCI:

Distal contractile integral

DES:

Distal esophageal spasm

DL:

Distal latency

DM:

Distal esophageal segments with myotomy

EGJOO:

Esophagogastric junction outflow obstruction

EPT:

Esophageal pressure topography

EUS:

Endoscopic ultrasonography

GERD:

Gastroesophageal reflux disease

GES:

Gastric electrical stimulation

G-POEM:

Gastric per-oral endoscopic myotomy

HREM:

High-resolution esophageal manometry

IRP:

Integrated relaxation pressure

LES:

Lower esophageal sphincter

LHM:

Laparoscopic Heller myotomy

PNM:

Proximal esophageal segments with no myotomy

POEM:

Per-oral endoscopic myotomy

SED:

Spastic esophageal disorder

TPS:

Trans-pyloric stenting

UES:

Upper esophageal sphincter

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Conflicts of Interest

Dr. Khashab is a consultant for Boston Scientific. All other authors have no relevant disclosures.

Author information

Authors and Affiliations

  1. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Majidah A. Bukhari, Payal Saxena & Mouen A. Khashab

  2. Department of Medicine and Division of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia

    Payal Saxena

  3. Department of Gastroenterology, Sheikh Zayed Tower, Suite M2058, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Majidah A. Bukhari

  4. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Building, 1800 Orleans Street, Suite 7125B, Baltimore, MD, 21287, USA

    Mouen A. Khashab

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  1. Majidah A. Bukhari
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Correspondence to Mouen A. Khashab .

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Editors and Affiliations

  1. Department of Surgery, University of Massachusetts / Baystate Medical Center, Springfield, Massachusetts, USA

    John R. Romanelli

  2. Division of Gastroenterology, University of Massachusetts / Baystate Medical Center, Springfield, Massachusetts, USA

    David J. Desilets

  3. Lowell Surgical Associates , North Chelmsford, Massachusetts, USA

    David B. Earle

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Bukhari, M.A., Saxena, P., Khashab, M.A. (2017). Per-oral Endoscopic Myotomy (POEM) for Non-achalasia Disorders. In: Romanelli, J., Desilets, D., Earle, D. (eds) NOTES and Endoluminal Surgery. Clinical Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-50610-4_7

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