Per Oral Endoscopic Myotomy (POEM) is a method of creating an oesophageal myotomy for achalasia and other oesophageal motor disorders that has established itself as credible alternative to laparoscopic myotomy. We (Jason Maani, Payal Saxena and Michael Talbot) presented comparative data between these techniques and a video detailing the operative steps recently at the Royal Australasian College of Surgeons Meeting in Brisbane.
Our Method: We played an operative video of the steps to perform the surgery and discussion about the published data, including some of the contentious issues that may determine if POEM will replace surgical myotomy.
POEM is an endoscopic procedure which is performed in four steps:
(1) the mucosal incision and entry into the submucosal space
(2) creation of the submucosal tunnel
(3) the myotomy itself and lastly
(4) closure of the mucosal incision
Our Results: POEM has an identical safety profile to laparoscopic myotomy with short and medium term studies indicating likely equivalence with regards to effective management of dysphagia and reflux outcomes.
POEM has supplanted other therapies for Jackhammer oesophagus and other conditions where long myotomies are required.
Type III achalasia appears to be better treated by POEM than Heller Myotomy and POEM maintains its effectiveness and safety profile in the treatment of patients who have failed surgical therapy or Pneumatic Dilation.
Our Conclusion: POEM is likely to become a dominant, if not the dominant myotomy technique in the near future. An understanding of the technical aspects and potential limitations of the procedure will be essential for surgeons practicing in this field.
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