Peroral endoscopic myotomy (POEM) for esophageal motility disorders other than achalasia

Abstract

Peroral endoscopic myotomy (POEM) is a novel minimally invasive procedure that has demonstrated excellent results in patients with all achalasia subtypes. In patients with non-achalasia disorders, POEM is more complex both in terms of preoperative evaluation and surgical technique. There are multiple studies that reported the results of POEM in patients with diffuse esophageal spasm and Jackhammer esophagus. POEM can potentially be the ideal endoscopic therapy for these motility disorders as it not only allows myotomy of the lower esophageal sphincter but also of the esophageal body, where the hypertensive contractions occur. In these patients, manometric diagnosis should be clear on careful review of their motility tracing. There have been promising reports of POEM in patients with esophago-gastric junction outflow obstruction, however, the data are still limited. In general, non-achalasia esophageal motility disorders are very rare and multicenter collaboration is required to develop an evidence-based methodology for POEM application in these disorders. The key to performa successful POEM is based on careful patient selection and complete pre-operative evaluation. GERD after POEM is common and management, goals of therapy, and long-term outcomes of GERD after POEM are unclear. Candidates should be appropriately counseled on expected outcomes and the need for long-term surveillance.