Peroral endoscopic myotomy periprocedural evaluation: Predicting and measuring outcomes

Peroral endoscopic myotomy (POEM) is a novel endoscopic operation for achalasia that creates a controlled myotomy across the esophagogastric junction, while offering the potential of reduced pain and convalescence when compared with laparoscopic Heller myotomy. However, the long-term efficacy of the procedure is yet to be determined. This article describes the symptom measures and tests of esophagogastric junction physiology that can be used to evaluate patients before, during, and after the POEM procedure. The Eckardt score and other quantitative symptom measures are discussed, as are physiological and diagnostic tests including high-resolution manometry, timed barium esophagram, upper endoscopy, functional lumen imaging probe, and pH monitoring. In combination, these metrics are essential in establishing the diagnosis of achalasia, choosing a treatment modality and predicting its efficacy, and evaluating outcomes after surgery. Additionally, the results of these quantitative evaluations serve as important research data to evaluate the long-term efficacy of POEM and compare it with the current standards of care, laparoscopic Heller myotomy and endoscopic pneumatic dilation.