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World J Gastrointest Endosc. Mar 16, 2015; 7(3): 237-246
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.237
Peroral endoscopic myotomy: Time to change our opinion regarding the treatment of achalasia?
Marcel Tantau, Dana Crisan
Marcel Tantau, Dana Crisan, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
Marcel Tantau, Dana Crisan, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, 400162 Cluj-Napoca, Romania
Author contributions: Both authors contributed to the literature review and the writing of the paper; Tantau M reviewed the paper and made the final corrections.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Dana Crisan, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania. crisan.dc@gmail.com
Telephone: +40-264-432625 Fax: +40-264-432625
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: November 1, 2014
Revised: November 15, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: March 16, 2015
Abstract

Peroral endoscopic myotomy (POEM) is a new endoscopic treatment for achalasia. Compared to the classical surgical myotomy, POEM brings at least the advantage of minimal invasiveness. The data provided until now suggest that POEM offers excellent short-term symptom resolution, with improvement of dysphagia in more than 90% of treated patients, with encouraging manometric outcomes and low incidence of postprocedural gastroesophageal reflux. The effectiveness of this novel therapy requires long-term follow-up and comparative studies with other treatment modalities for achalasia. This technique requires experts in interventional endoscopy, with a learning curve requiring more than 20 cases, including training on animal and cadaver models, and with a need for structured proctoring during the first cases. This review aims to summarize the data on the technique, outcomes, safety and learning curve of this new endoscopic treatment of achalasia.

Keywords: Peroral endoscopic myotomy, Achalasia, Myotomy, Endoscopic treatment

Core tip: This review aims to highlight the importance of a new minimally invasive technique for the treatment of achalasia, compared to classical surgical treatment. Although discovered recently, this method has already imposed itself as a safe and very efficient therapy. The difficult issue in this topic is related to the specialist who performs it and the learning curve in such a rare pathology. The gastroenterologist has to be expert in interventional endoscopy and have special skills in surgery, an excellent knowledge in anatomy and the strength to manage the complications. Considering the low rate of adverse events and the efficacy, as a team already performing POEM, we believe that this is the therapy of the future for achalasia.