Extended indications and contraindications for peroral endoscopic myotomy

Peroral endoscopic myotomy (POEM) has proven a remarkably efficacious and safe therapy for patients with typical achalasia in preliminary, short-term, and intermediate-term reports. However, less is known about the feasibility and outcomes of POEM in patients with other hypercontractile motility disorders, prior failed conventional treatments, age extremes, end-stage achalasia, or significant comorbidities. We review the literature data regarding extended indications and contraindications of POEM. The scant data from the literature are augmented by extrapolating from data in the laparoscopic Heller myotomy literature where appropriate (as POEM is essentially a surgical Heller myotomy performed via a natural orifice). We also make limited use of data from an international POEM survey.