Advances in POEM for Achalasia: Optimal Technique, Post-POEM GERD

Abstract

Peroral endoscopic myotomy (POEM) is a novel procedure introduced into clinical practice by Inoue in 2010 for the treatment of achalasia. It is a safe and efficient procedure but with unknown long-term consequences of post-treatment gastroesophageal reflux (GER). Compared with surgical Heller myotomy with fundoplication, endoscopic myotomy has no standardized complementary procedure to prevent reflux. Several techniques aiming at diminishing the risk of post-procedural reflux have been described in the literature with promising outcomes. The double-scope technique (DST) is recommended by the Japanese Consensus for POEM, but endoscopic fundoplication procedures such as transoral incisionless fundoplication (TIF) and fundoplication using the NOTES approach (POEM-F) may play a major role in the primary prophylaxis for post-POEM GER. Reflux occurring after endoscopic myotomy is a clinically relevant issue. Different techniques to minimize or prevent post-procedural reflux are now available but further research is needed.