POEM (English version)


Peroral endoscopic myotomy (POEM) is a new endoscopic technique for the management of achalasia and spastic esophageal disorders not responding to medical therapies (such as diffuse esophageal spam, nutcracker esophagus). As the name implies, POEM is performed perorally without any incisions in the chest or abdomen.

POEM steps are as follows:

(1) the endoscope is passed through your mouth and into the esophagus where the therapy will be applied ;

(2) your esophagus will be examined in detail;

(3) an initial incision will be made in the internal lining of the esophagus using an electrosurgical knife;

(4) the endoscope will entered through this incision (opening) to within the wall of the esophagus;

(5) the muscle layer of the esophagus will be exposed;

(6) the inner layer of the muscle near the lower esophageal sphincter will be cut;

(7) after the procedure, the esophageal opening (incision) will be closed with endoscopic clips.

Before procedure, a correct diagnosis of achalasia must be proven. For this reason symptom scores, high-resolution esophageal manometry tracings and contrast esophagrams should be examined in detail.


The POEM procedure has been adapted to be performed in the stomach (termed gastric or G-POEM) for the treatment of severe gastroparesis (difficulty in stomach emptying) that is refractory to medical therapy in selected patients. G-POEM consists of the similar steps as described above for POEM. However the procedure is performed in the stomach, and the muscle fibers nearby the gastric (stomach) outlet (termed pylorus) are cut in this technique. Gastric emptying studies are performed before, and after the procedure for follow-up to assess the effect of the G-POEM on gastric emptying.