Per Oral Endoscopic Myotomy, Equipment and Technique: A Step-by-Step Explanation

Per oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgical technique for ‘scarless’ Heller myotomy for the treatment of achalasia. It utilizes a submucosal tunnel approach that offsets the mucosal and muscle incisions and thus allows secure closure with a few clips on the mucosotomy site. The first POEM procedure was performed in Japan by Haruhiro Inoue in 2008. Since then POEM has steadily grown to several hundred procedures worldwide at this point. Published data are limited but demonstrate high efficacy and low complication rates at expert centers pioneering this procedure. POEM techniques are reviewed, along with tips and tricks, in the submitted video. It should be emphasized that POEM is a challenging endoscopic surgical procedure that requires advanced endoscopic resectional skills, particularly endoscopic submucosal dissection skills. There is unanimity among current operators that POEM should be performed under institutional review board approval and after appropriate laboratory training and proctoring of the initial human POEM case(s). There is very strong consensus in favor of rigorous external accreditation and monitoring of outcomes to ensure competence and safety. This article is part of an expert video encyclopedia.