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Copyright ©2013 Baishideng Publishing Group Co.
World J Gastrointest Endosc. Sep 16, 2013; 5(9): 420-427
Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.420
Table 2 Evolution of per-oral endoscopic myotomy: A single center experience
InitialSubsequentRationale
Performed in operating room with surgeon presentPerformed in endoscopy suite with surgeon availableDemonstrated to be a predictable and safe procedure. Moderate procedural time
Selected patients had no prior achalasia interventionSelected patients include those with prior intervention (BTI, PD, HM)POEM results here and elsewhere
Use of dilation balloons to dissect submucosal tunnelNo or little use of balloon. Evolution from needle knife to IT knife and now hybrid knifeExperience. More reliable dissection with knives. Hybrid knife with flushing capability
Variable orientation of initial incision sitePreference for 5 o’clock positionImproved dysphagia relief
Short myotomy-less than 6 cmMyotomy tailored to manometry findings and components of Eckardt scorePOEM results here and elsewhere
Partial LES myotomy of circular muscle onlyPreference for complete myotomy unless low LESP on manometryConcern for POEM efficacy. Post-POEM GERD usually manageable with medication