The Modern Age of POEM: the Past, Present and Future of Per-Oral Endoscopic Myotomy

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...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2021-02, Vol.25 (2), p.551-557
Main Authors: Haisley, Kelly R., Swanström, Lee L.
Format: Article
Language:English
Subjects:
Disease
Endoscopy
Esophageal Achalasia - surgery
Esophageal diseases
Esophageal Motility Disorders - surgery
Esophageal Sphincter, Lower - surgery
Esophagoscopy
Esophagus
Gastroenterology
Humans
Medicine
Medicine & Public Health
Motility
Natural Orifice Endoscopic Surgery
Pyloromyotomy
Reimbursement
Review Article
Surgeons
Surgery
Treatment Outcome
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Summary: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.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-020-04815-z