What is Per-oral endoscopic myotomy


 Per-oral endoscopic myotomy


POEM (Per oral Endoscopic Myotomy) is an advanced endoscopic procedure used to treat Achalasia and other swallowing disorders. It can take about 2-3 hours and requires inpatient admission.

 It is done using a high-definition endoscope and a dye which aids in identification of the layers of the esophagus. Longitudinal hydro-dissection is done (creation of third space) until the LES is reached. 

Selective myotomy of the inner circular muscles or sometimes full-thickness myotomy is done. Any active minor bleeding is cauterized and clips are used for suturing.


Indications: -

 1. Achalasia

 2.Diffuse esophageal spasm 

 3. Nutcracker esophagus 


Special note: - 

1) POEM reported more clinical response compared to laparoscopic myotomy. 

2) Rate of adverse events lower in POEM compared to laparoscopic myotomy therefore is a safer clinical alternative 

3) Improvement in dysphagia is more pronounced in POEM

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