ABSTRACT
Per oral endoscopic myotomy (POEM) is an effective treatment for all types of achalasia and has been reported for patients from age 3 to late 90s. It has been shown to be safe and effective for end-stage or "sigmoid" esophagus as well as reoperative cases. Aside from achalasia, POEM has been used for diffuse esophageal spasm (DES), hypertensive LES, spastic achalasia, and nutcracker esophagus. POEM requires general anesthesia and is therefore contraindicated in patients with severe pulmonary disease, cirrhosis, portal hypertension, and coagulopathy. Achalasia patients should always have a comprehensive symptom assessment covering typical presenting symptoms including dysphagia, chest pain, regurgitation of undigested foods, weight loss, and previous interventions, all of which have been shown to affect outcomes of any treatments. Esophageal manometry is the single most important test, as it definitively establishes the diagnosis of achalasia. POEM represents a true minimally invasive advance in the treatment of achalasia.
