Peroral Endoscopic Myotomy (POEM) for Achalasia

Achalasia is a possible differential diagnosis in patients who has difficulty swallowing. It is generally considered to be a degenerative disorder where the lower oesophageal muscles fail to relax during normal swallowing and lead to food “hold up”. POEM (Peroral Endoscopic Myotomy) was introduced by Prof. H Inoue in 2008. This most advanced and effective procedure is slowly becoming a new standard in the treatment of achalasia. The procedure involves creation of a submucosal tunnel in the mid-oesophagus follow by myotomy of the circular muscles of the oesophageal wall. The length of myotomy is generally longer than surgical myotomy, however in surgery, the mytomy is full thickness. All patients had dysphagia relief, 83% to 94% having relief of noncardiac chest pain. Mild gastroesophageal reflux in 46% of patients is expected after this treatment, although most will not require medication.