Peroral Endoscopic Myotomy (POEM) and Its Use in Esophageal Dysmotility

The aim of this review is to provide an overview of peroral endoscopic myotomy (POEM) and its utilization in major motor disorders of the esophagus. POEM, a relatively novel endoscopic technique, involves a mucosal incision followed by submucosal tunneling to access esophageal muscle layers, enabling selective myotomy and mitigating the consequences of motor disorders of the esophagus. A number of recent studies have demonstrated noninferiority in shorter myotomy lengths in nonspastic (type I and II) achalasia as compared with standard-length myotomy, which has ramifications for procedural length, reflux disease, and more. Long-term data on POEM as a treatment modality for achalasia have demonstrated its robustness in providing a durable and sustainable treatment response. Challenges of POEM include the learning curve associated with mastering this technique, as well as the management of possible procedural complications including ineffective myotomy, blown-out myotomy, and/or gastroesophageal reflux disease. In conclusion, POEM has been demonstrated to be an effective and durable treatment option for achalasia and has an increasing role in other motility disorders of the esophagus.