Abstract
Per-Oral Endoscopic Myotomy (POEM) is an evolving treatment modality for Achalasia. Standard steps of POEM include a 2 cm mucosotomy in mid esophagus, creation of submucosal tunnel extending 2-4 cm onto gastric side, then dividing the inner circular muscle in distal 5-6 cm of esophagus and extending 2-4 cm on gastric side, and closure of mucosotomy with endoscopic clips. Prior treatments such as Botox injections, Pneumatic dilation or Heller's myotomy pose a technical challenge due to submucosal fibrosis adding complexity.
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