The Modern Age of POEM: the Past, Present and Future of Per-Oral Endoscopic Myotomy
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REVIEW ARTICLE
The Modern Age of POEM: the Past, Present and Future of Per-Oral Endoscopic Myotomy Kelly R. Haisley 1
&
Lee L. Swanström 2,3
Received: 6 February 2020 / Accepted: 30 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Per-oral endoscopic myotomy (POEM) has gained widespread enthusiasm amongst foregut specialists since its introduction in the mid 2000s as an effective and less invasive treatment option for achalasia. As more than 6000 POEM procedures have been performed to date throughout the world, we aim to summarize the history and current state of POEM in the treatment of esophageal motility disorders. Methods We performed a comprehensive review of the published literature focusing on the history and development of the POEM procedure, and its most current applications and outcomes. Results Multiple favorable long-term studies have been published advocating for the use of POEM as a valid and perhaps the most valid treatment option for achalasia. The procedure is also increasingly being applied to a wider spectrum of esophageal motility disorders including type III achalasia, spastic esophageal disease or isolated lower esophageal sphincter (LES) dysfunction, as well as new endoluminal procedures such as submucosal tumor endoscopic resection (STER), endoscopic fundoplications (POEM-F) and peroral pyloromyotomy (POP or G-POEM). Conclusions While POEM is a proved and valid procedure, its further adoption is being threatened by external factors: challenges related to teaching, institutional support (politics) and insurance reimbursement. While this technique has come an incredible distance in its relatively short lifespan, the future of POEM in the USA will depend on the support from surgical societies to validate it as a valuable tool in the esophageal specialist’s armamentarium, and to encourage a commitment to training in endoluminal surgery. Keywords POEM . Review . Heller . Esophageal myotomy
Introduction Since its introduction in the mid-2000s, per-oral endoscopic myotomy (POEM) has become an increasingly popular treatment for the management of achalasia and other esophageal motility disorders around the world based on sound outcomes
* Kelly R. Haisley [email protected] 1
Division of Gastrointestinal and General Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
2
IHU-Strasbourg Institute of Image-Guided Surgery, Strasbourg, France
3
Providence Portland Medical Center, 4805 NE Glisan Street, Suite 6N60, Portland, OR 97213, USA
evidence. In the past decade, a multitude of publications have evaluated the safety, efficacy, and indications for POEM in the modern surgical management of esophageal disease with uniformly promising results both alone1–4 and when compared with the standard therapy of Heller myotomy. 5–8 Furthermore, as the procedure ages, longer-term data from the USA and around the world has not shown any major deterioration in these outcomes.9–11 POEM’s innovative and logical approa
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