<p>Peroral Endoscopic Myotomy as a Novel Treatment for Achalasia: Patient Selection and Perspectives</p>

Abstract

Achalasia is a rare esophageal motility disorder characterized by esophageal aperistalsis and impaired relaxation of lower esophageal sphincter. There is no cure for achalasia and all the current treatments are aimed at palliation of symptoms by reducing the lower esophageal sphincter pressure. Currently, laparoscopic Heller myotomy (LHM) with partial fundoplication is considered the most effective and durable treatment option owing to its superiority over other treatments such as pneumatic dilation. Advancements in interventional endoscopy led to a novel minimally invasive endoscopic alternative to LHM, namely peroral endoscopic myotomy (POEM). In the last decade since its inception, POEM expanded rapidly throughout the world due to excellent safety profile and its efficacy comparable to LHM. The main drawback of POEM is gastroesophageal reflux disease since it is not combined with an anti-reflux procedure. The current review focuses on the indications, contraindications, technique, outcomes of POEM in various patient populations, and complications along with its effectiveness in comparison to LHM and pneumatic dilation.

Therapeutic Upper Gastrointestinal Endoscopy in Pediatric Gastroenterology

“…Achalasia is a rare progressive motility disorder, characterized by esophageal aperistalsis and impaired LES relaxation, leading to increased dysphagia of solids and liquids and regurgitation of indigested contents (77)(78)(79)(80)(81)(82). Its presentation is particular in adult life, and diagnosis in childhood is quite rare.…”

“…Current management includes laparoscopic Heller myotomy (LHM), POEM, pneumatic dilatation, and the injection of botulinum toxin. Since its first description in 2010 by Inoue et al, POEM has become an effective and safe procedure worldwide with the advantage of significant lower operation time and a shorter length of stay, and hence, it has replaced LHM as first-line treatment in adults (77,82).…”

“…Clinical success rates in adults vary between 82 and 100% with particularly good results in patients with prior failed therapy: a recent meta-analysis indicates a 98% success rate in patients who had failed LHM (77). POEM has now been reported in children.…”

Peroral Endoscopic Myotomy

“…Classic symptoms of achalasia include heartburn, dysphagia, regurgitation (Brindise et al, 2021), chest pain, and weight loss (Chadalavada, Thota, Raja, & Sanaka, 2020). Achalasia is the leading indication for performance of peroral endoscopic myotomy to alleviate its symptoms, more frequently referred to by the acronym “POEM” (Chadalavada et al, 2020). POEMs are increasingly practiced worldwide since its original advent (Fajardo, Petrov, Bakhos, & Abbas, 2020).…”

“…In the United States, it is estimated that 20,000–40,000 patients are affected by it, occurring equally amongst genders (Vaezi, Pandolfino, Yadlapati, Greer, & Kavitt, 2020) with no racial correlation (Brindise, Khashab, & El Abiad, 2021). Classic symptoms of achalasia include heartburn, dysphagia, regurgitation (Brindise et al, 2021), chest pain, and weight loss (Chadalavada, Thota, Raja, & Sanaka, 2020). Achalasia is the leading indication for performance of peroral endoscopic myotomy to alleviate its symptoms, more frequently referred to by the acronym “POEM” (Chadalavada et al, 2020).…”