The POEM bottom-up technique for achalasia
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and Other Interventional Techniques
The POEM bottom‑up technique for achalasia Gad Marom1 · Harold Jacob2 · Ariel Benson2 · Tiberiu Hershcovici2 · Rachel Gefen1 · Jonathan B. Yuval1 · Ronit Brodie1 · Avraham I Rivkind1 · Yoav Mintz1 Received: 4 April 2020 / Accepted: 16 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background POEM (Per Oral Endoscopic Myotomy) is rapidly becoming a valid option for surgical myotomy in achalasia patients. Several techniques to perform POEM are described, but all concentrate on the division of the circular muscle fibers in a proximal-to-distal fashion. Our aim is to present the distal-to-proximal, or the bottom-up technique using the Flush/Dual knife, which overcomes the disadvantages of the standard technique. Methods A retrospective study on a prospectively maintained database was performed on all patients treated by POEM in our institution. Clinical presentation, operating time, adverse events, and outcomes were studied. Results POEM was performed on 105 achalasia patients. The first 15 cases were performed using the standard technique and were compared to the next 90 cases performed using the bottom-up technique. The average preop Eckardt scores in the standard and bottom-up groups were 9.5 and 8.8, respectively, declining to 1.4 and 0.5, 3 months post myotomy (p
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