Per-oral endoscopic myotomy white paper summary

Achalasia is an uncommon esophageal motility disorder in which there is selective loss of inhibitory neurons resulting in loss of peristalsis and failure of adequate relaxation of the lower esophageal sphincter (LES) in response to food bolus. There is no current curative treatment that reverses the pathophysiology of achalasia. The treatment options are aimed at improving the passage of solids and liquids through the gastroesophageal junction (GEJ). The traditional treatment options include surgical myotomy and endoscopic methods that disrupt or weaken the LES, such as endoscopic balloon dilation and botulinum toxin injection (BI). Per-oral endoscopic myotomy (POEM) represents a natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy. Preliminary data suggest that this minimally invasive endoscopic procedure may achieve clinical results similar to those of surgical myotomy. As part of the annual Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) meeting held in Chicago in July 2012, a conference was organized to collaboratively review POEM and develop a consensus document on the current status of POEM. An International POEM Survey (IPOEMS) was designed and conducted by the session moderators as part of this NOSCAR initiative to attempt to supplement the scant published literature with current data from POEM early adopters. The survey, which has now been published in detail, 1 included 5 Asian, 7 North American, and 4 European expert centers with a combined experience of 841 POEM procedures, including all high-volume centers (>30 cases per center) at the time of the survey in July 2012. These data span every aspect of POEM and were made available to the NOSCAR POEM panel presenters to assist them with preparation of their panel presentations that served as the basis of this white paper.