Definition and Context
POEM is a minimally invasive endoscopic technique for performing a calibrated myotomy of the esophageal circular muscle 1. The procedure involves accessing the esophageal muscle layers through the mouth (per-oral) using an endoscope to perform a controlled cutting (myotomy) of the lower esophageal sphincter and distal esophageal musculature.
Clinical Application
This procedure has emerged as a robust treatment option for achalasia and related esophageal motility disorders 1, 2. The technique allows endoscopists to create a submucosal tunnel and selectively divide the circular muscle fibers of the esophagus, effectively relieving the obstruction at the esophagogastric junction that characterizes achalasia.
Key Clinical Points:
- POEM is considered primary therapy for type III achalasia when expertise is available 1, 2
- For other achalasia subtypes, it represents a treatment option comparable to laparoscopic Heller myotomy 1, 3
- The procedure requires 20-40 cases to achieve competence and should be performed in high-volume centers by experienced physicians 1
- Post-POEM patients face high risk for reflux esophagitis and may require indefinite proton pump inhibitor therapy 1, 2
The acronym reflects the three essential components of the procedure: the route of access (per-oral/through the mouth), the method (endoscopic), and the surgical action performed (myotomy/muscle cutting).