Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure primarily designed for the treatment of achalasia, a disorder characterized by the inability of the lower esophageal sphincter to relax, leading to difficulty in swallowing, chest pain, and regurgitation. The procedure is performed under sedation and utilizes specialized endoscopic techniques to create a myotomy, which is a surgical incision in the muscle fibers of the esophagus, specifically targeting the lower esophageal sphincter and the proximal stomach. During POEM, the endoscopist first inserts an endoscope through the mouth and navigates down the esophagus to the site of the obstructed lower esophageal sphincter. A submucosal injection is administered to lift the mucosal layer away from the underlying muscle, allowing for the creation of a tunnel within the esophageal wall. This tunnel enables the surgeon to access the muscle layer without impacting the overlying mucosa, significantly reducing the risk of complications. Once access is achieved, the muscle fibers of the lower esophageal sphincter are carefully dissected, which relieves the pressure and allows for improved passage of food into the stomach. The procedure has gained popularity due to its effectiveness and relatively low complication rates compared to traditional surgical options, like Heller myotomy, which typically require larger abdominal incisions. Patients undergoing POEM usually experience a short hospital stay, rapid recovery, and significant improvement in swallowing and quality of life. The procedure is also notable for its versatility, as it can be adapted for patients with various esophageal disorders beyond achalasia, including spastic esophageal disorders and other motility issues. Furthermore, POEM can be completed in an outpatient setting, reflecting advancements in endoscopic techniques and patient care. Postoperative management often involves a specialized diet and follow-up care to monitor for potential complications such as gastroesophageal reflux disease (GERD), which may arise from the disruption of the lower esophageal sphincter. Research indicates that POEM yields positive results in around 80 to 90 percent of patients, with many experiencing complete resolution of symptoms and improved quality of life following the procedure. As ongoing studies continue to illuminate the long-term outcomes and efficacy of POEM, the procedure stands as a robust option in the treatment of achalasia and other esophageal motility disorders, offering hope and relief to patients who have struggled with these debilitating conditions. Overall, POEM represents a significant advancement in the field of gastrointestinal surgery, merging efficacy with a patient-centered approach, ultimately transforming the management of esophageal disorders.
