Peroral endoscopic myotomy for esophageal motility disorders

Peroral endoscopic myotomy (POEM) is a procedure that treats swallowing disorders.The procedure is done endoscopically without the need for surgery (Video 1, available online at www.videogie.org). INDICATIONSPOEM is a treatment option for patients who have swallowing issues such as symptomatic type I, II, or III achalasia, diffuse esophageal spasms, or hypercontractile esophagus, which is sometimes referred to as jackhammer esophagus or nutcracker esophagus.1 CONTRAINDICATIONSPatients with severe erosive esophagitis, significant coagulation (bleeding) disorders, liver cirrhosis with portal hypertension, or prior medical treatments that may have affected the strength of the esophageal mucosa or caused submucosal fibrosis may not be suitable candidates for POEM.Some of these treatments include radiation, endoscopic mucosal resection, and radiofrequency ablation.However, previous treatments for achalasia are not a reason to not have this procedure to POEM.