Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Main Recommendation

1 A POEM equipment checklist should be used before commencing the procedure to ensure the availability and proper functioning of all necessary materials.

2 A thorough esophageal cleansing before mucosal incision is mandatory. There should be no residual dietary liquid or food in the lumen.

3 Use at least 5–10 mL of lifting agent, which should be injected using a needle at the desired point where the mucosotomy will commence.

4 To create the mucosotomy, the first incision should be made at the site of previous injection with the fewest possible taps on the electrosurgical unit using a cutting mode, with the knife tip at 45–80° to the mucosal surface.

5 After adequate submucosal injection (through a needle or knife), the incision should be extended by 1.5–2 cm in the longitudinal axis from cranial to caudal, in the planned direction of the tunnel.

6 Dissection within the tunnel should be performed using sequential injection of saline and chromic dye (if available using the knife jet function) and dissection with the knife. Pushing the endoscope forward gently against the advancing submucosa–muscularis propria interface is important to facilitate mucosal tunneling.

7 The myotomy should be performed in a cranial to caudal manner, starting 2 cm or more below the caudal extent of the mucosotomy site.

8 ESGE recommends that the myotomy should be extended 2–3 cm distal to the gastroesophageal junction to allow complete disruption of the lower esophageal sphincter.

9 ESGE recommends that POEM can be performed on either the anterior (1–2 o’clock in supine position) or posterior (5–6 o’clock) side.

10 ESGE recommends that the myotomy length should be tailored to the disease being treated, with evidence favoring short esophageal-side myotomy if indicated because of decreased adverse events and procedure times.

11 ESGE recommends the use of through-the-scope clips for mucosal closure owing to their high efficacy and availability, and lower price compared with other closure methods.

12 Mucosal injury during POEM should be proactively sought during the procedure and particularly before completion. Mucosal injury can be represented on a spectrum from whitening of the overlying mucosa to a full-thickness perforation.

13 ESGE recommends performing POEM using low flow CO₂ insufflation.

14 In the absence of adverse events, resume fluids on day 1, soft diet on day 3, and normal diet on day 7 post-POEM.

15 ESGE recommends against the routine use of standard or computed tomography fluoroscopic esophagrams after POEM in asymptomatic patients.

^‡ joint first co-authorship.

^* joint senior authors.

Publikationsverlauf

Artikel online veröffentlicht:
28. Mai 2025

• References

• 1 Oude Nijhuis R, Zaninotto G, Roman S. et al. European Guideline on Achalasia – UEG and ESNM recommendations. United European Gastroenterol J 2020; 8: 13-34
• 2 Weusten BLAM, Barret M, Bredenoord AJ. et al. Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 498-515
• 3 Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013; 108: 1238-1249 quiz 1250
• 4 Sadowski DC, Ackah F, Jiang B. et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 2010; 22: e256-e261
• 5 Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014; 383: 83-93
• 6 Rodríguez de Santiago E, Tate DJ, Santos-Antunes J. et al. Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2025;
• 7 Gralnek IM, Bisschops R, Matharoo M. et al. Guidance for the implementation of a safety checklist for gastrointestinal endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54: 206-210
• 8 Hathorn KE, Chan WW, Aihara H. et al. Determining the safety and effectiveness of electrocautery enhanced scissors for peroral endoscopic myotomy (with video). Clin Endosc 2020; 53: 443-451
• 9 Shimizu T, Fortinsky KJ, Chang KJ. Early experience with use of an endoscopic “hot” scissor-type knife for myotomy during per-oral endoscopic myotomy procedure. VideoGIE 2019; 4: 182-184
• 10 Belopolsky Y, Puli SR. Water-jet vs traditional triangular tip knife in peroral endoscopic myotomy for esophageal dysmotility: A systemic review and meta-analysis. World J Gastrointest Endosc 2022; 14: 608-615
• 11 Cai M-Y, Zhou P-H, Yao L-Q. et al. Peroral endoscopic myotomy for idiopathic achalasia: randomized comparison of water-jet assisted versus conventional dissection technique. Surg Endosc 2014; 28: 1158-1165
• 12 Tanaka S, Toyonaga T, Kawara F. et al. Peroral endoscopic myotomy using FlushKnife BT: a single-center series. Endosc Int Open 2017; 5: E663-E669
• 13 Haito-Chavez Y, Inoue H, Beard KW. et al. Comprehensive analysis of adverse events associated with per oral endoscopic myotomy in 1826 patients: an international multicenter study. Am J Gastroenterol 2017; 112: 1267-1276
• 14 Weusten BLAM, Barret M, Bredenoord AJ. et al. Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 600-614
• 15 American Association for the Study of Liver Diseases, European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol 2014; 61: 642-659
• 16 Nishihara Y, Yoshida T, Ooi M. et al. Anesthetic management and associated complications of peroral endoscopic myotomy: A case series. World J Gastrointest Endosc 2018; 10: 193-199
• 17 Sarkar S, Khanna P, Gunjan D. Anesthesia for per-oral endoscopic myotomy (POEM) – not so poetic!. J Anaesthesiol Clin Pharmacol 2022; 38: 28-34
• 18 Bang Y-S, Park C. Anesthetic consideration for peroral endoscopic myotomy. Clin Endosc 2019; 52: 549-555
• 19 Yoon HJ, Youn YH, Yoo SH. et al. Effect of drinking warm water on esophageal preparation before peroral endoscopic myotomy in patients with achalasia. J Neurogastroenterol Motil 2022; 28: 231-236
• 20 Inoue H, Shiwaku H, Iwakiri K. et al. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc 2018; 30: 563-579
• 21 Tanaka E, Murata H, Minami H. et al. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series. J Anesth 2014; 28: 456-459
• 22 Yang D, Pannu D, Zhang Q. et al. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit. Endosc Int Open 2015; 3: E289-E295
• 23 Hastier-De Chelle A, Onana-Ndong P, Olivier R. et al. Impact of antibiotic prophylaxis and conditioning modalities in per-oral endoscopic myotomy for esophageal motor disorders. Scand J Gastroenterol 2022; 57: 1522-1530
• 24 Zhang LY, Ngamruengphong S. Contemporary management of antithrombotic agents for patients undergoing peroral endoscopic myotomy. Gastrointest Endosc 2021; 93: 850-852
• 25 Shiwaku H, Inoue H, Onimaru M. et al. Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan. Surg Endosc 2020; 34: 464-468
• 26 Shiwaku H, Inoue H, Sato H. et al. Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan. Gastrointest Endosc 2020; 91: 1037-1044.e2
• 27 von Renteln D, Fuchs K-H, Fockens P. et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 2013; 145: 309-311.e1–e3
• 28 Rodríguez de Santiago E, Shimamura Y, Pioche M. et al. Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study. Gastrointest Endosc 2021; 93: 839-849
• 29 Nakamura J, Hikichi T, Hashimoto M. et al. Efficacy and safety of peroral endoscopic myotomy for esophageal achalasia and achalasia-related diseases in patients aged 75 years and over. Healthcare (Basel) 2021; 9: 1668
• 30 Shimamura Y, Sato H, Onimaru M. et al. Per-oral endoscopic myotomy in patients with antithrombotic agents: A large-scale multicenter study in Japan. J Gastroenterol Hepatol 2022; 37: 480-488
• 31 Nakai T, Abe H, Tanaka S. et al. Risk-scoring system for predicting challenging cases of peroral endoscopic myotomy. Dig Endosc 2023; 35: 729-735
• 32 Drexel S, Bingmer K, Anderson M. et al. An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy. Surg Endosc 2021; 35: 5620-5625
• 33 Maselli R, Oliva A, Badalamenti M. et al. Single-dose versus short-course prophylactic antibiotics for peroral endoscopic myotomy: a randomized controlled trial. Gastrointest Endosc 2021; 94: 922-929
• 34 Nabi Z, Bhaware B, Ramchandani M. et al. Single-versus multiple-dose antimicrobial prophylaxis in peroral endoscopic myotomy: a randomized controlled study (SMAPP trial). Dysphagia 2023; 38: 1581-1588
• 35 Zhai Y, Linghu E, Li H. et al. Is preoperative antibiotics necessary for infection prevention before peroral endoscopic myotomy: 1939. Am J Gastroenterol 2013; 108: S587
• 36 Zhu B-Q, Cai M-Y, Zhang X-C. et al. Sa1084. Benefit of preoperative antibiotic prophylaxis for peroral endoscopic myotomy (POEM): a randomized controlled trial. . Gastrointest Endosc 2017; 85: AB184-AB185
• 37 Bayer J, Vackova Z, Svecova H. et al. Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis. Surg Endosc 2018; 32: 300-306
• 38 Serrano L, Saad AR, DuCoin C. et al. Discordance between high-resolution manometry, esophagoscopy and contrast esophagogram in determining landmarks for per-oral endoscopic myotomy in spastic esophageal disorders: a word of caution. Surg Endosc 2021; 35: 5613-5619
• 39 Bechara R, Onimaru M, Ikeda H. et al. Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc 2016; 84: 330-338
• 40 Lambin T, Rivory J, Wallenhorst T. et al. Endoscopic submucosal dissection: How to be more efficient?. Endosc Int Open 2021; 9: E1720-E1730
• 41 Inoue S, Uedo N, Tabuchi T. et al. Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection. Endosc Int Open 2020; 8: E1044-E1051
• 42 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 43 Rex DK, Lahr RE, Peterson MM. et al. Impact of including epinephrine in the submucosal injectate for colorectal EMR on postprocedural pain: a randomized controlled trial. Gastrointest Endosc 2022; 95: 535-539 e1
• 44 Werner YB, von Renteln D, Noder T. et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc 2017; 85: 708-718.e2
• 45 Hanada Y, Wang KK. Safety and feasibility of same-day discharge after esophageal endoscopic submucosal dissection. Gastrointest Endosc 2021; 93: 853-860
• 46 Khashab MA, Messallam AA, Saxena P. et al. Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy. Endoscopy 2014; 46: 298-301
• 47 Nabi Z, Nageshwar Reddy D. Impact of modified techniques on outcomes of peroral endoscopic myotomy: A narrative review. Front Med (Lausanne) 2022; 9: 948299
• 48 Ramchandani M, Nageshwar Reddy D. Peroral endoscopic myotomy: technique of mucosal incision. Clin Gastroenterol Hepatol 2014; 12: 900-901
• 49 Chai N-L, Li H-K, Linghu E-Q. et al. Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol 2019; 25: 744-776
• 50 Peng W, Li H, Xu Y. et al. Near-focus mode for accurate operation during endoscopic submucosal tunneling procedure. Minim Invasive Ther Allied Technol 2022; 31: 99-106
• 51 Bapaye J, Bharadwaj T, Bapaye A. et al. Simple mathematical equation to predict distance to gastroesophageal junction through the submucosal tunnel during peroral endoscopic myotomy. Endosc Int Open 2019; 7: E1371-E1378
• 52 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
• 53 Ahmed Y, Othman MO. Peroral endoscopic myotomy (POEM) for achalasia. J Thorac Dis 2019; 11: S1618-S1628
• 54 Minami H, Inoue H, Haji A. et al. Per-oral endoscopic myotomy: emerging indications and evolving techniques. Dig Endosc 2015; 27: 175-181
• 55 Tanaka S, Kawara F, Toyonaga T. et al. Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy. Dig Endosc 2018; 30: 206-211
• 56 Inoue H, Shiwaku H, Kobayashi Y. et al. Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience. Esophagus 2020; 17: 3-10
• 57 Khashab MA, Kumbhari V, Azola A. et al. Intraoperative determination of the adequacy of myotomy length during peroral endoscopic myotomy (POEM): the double-endoscope transillumination for extent confirmation technique (DETECT). Endoscopy 2015; 47: 925-928
• 58 Grimes KL, Inoue H, Onimaru M. et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc 2016; 30: 1344-1351
• 59 Marom G, Jacob H, Benson A. et al. The POEM bottom-up technique for achalasia. Surg Endosc 2021; 35: 6117-6122
• 60 Ramchandani M, Nabi Z, Reddy DN. et al. Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study. Endosc Int Open 2018; 6: E190-E198
• 61 Tan Y, Lv L, Wang X. et al. Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study. Gastrointest Endosc 2018; 88: 46-54
• 62 Khashab MA, Sanaei O, Ponchon T. et al. Peroral endoscopic myotomy (POEM): anterior versus posterior approach, a randomized single-blinded clinical trial. Gastrointest Endosc 2018; 87: AB119
• 63 Stavropoulos SN, Modayil RJ, Zhang X. et al. Is there a difference in outcomes between anterior and posterior peroral endoscopic myotomy (POEM)? A randomized study from an experienced high-volume operator.. Gastrointest Endosc 2018; 87: AB121-AB122
• 64 Rodríguez de Santiago E, Mohammed N, Manolakis A. et al. Anterior versus posterior myotomy during poem for the treatment of achalasia: systematic review and meta-analysis of randomized clinical trials. J Gastrointest Liver Dis 2019; 28: 107-115
• 65 Onimaru M, Inoue H, Ikeda H. et al. Greater curvature myotomy is a safe and effective modified technique in per-oral endoscopic myotomy (with videos). Gastrointest Endosc 2015; 81: 1370-1377
• 66 Ichkhanian Y, Abimansour JP, Pioche M. et al. Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial. Endoscopy 2021; 53: 462-468
• 67 Khashab MA, Sanaei O, Rivory J. et al. Peroral endoscopic myotomy: anterior versus posterior approach: a randomized single-blinded clinical trial. Gastrointest Endosc 2020; 91: 288-297.e7
• 68 Jing W, Luo X, Yang J. et al. An updated meta-analysis: Similar clinical efficacy of anterior and posterior approaches in peroral endoscopic myotomy (POEM) for achalasia. Gastroenterol Res Pract 2022; 2022: 8357588
• 69 Mohan BP, Ofosu A, Chandan S. et al. Anterior versus posterior approach in peroral endoscopic myotomy (POEM): a systematic review and meta-analysis. Endoscopy 2020; 52: 251-258
• 70 Abdelfatah MM, Barakat M. Peroral endoscopic myotomy: the anterior approach is associated with a higher incidence of accidental mucosotomy compared to posterior approach, systematic review, and meta-analysis. Eur J Gastroenterol Hepatol 2019; 31: 1166-1167
• 71 Shiwaku H, Inoue H, Shiwaku A. et al. Safety and effectiveness of sling fiber preservation POEM to reduce severe post-procedural erosive esophagitis. Surg Endosc 2022; 36: 4255-4264
• 72 Nabi Z, Chandran V, Basha J. et al. Conventional versus oblique fiber sparing endoscopic myotomy for achalasia cardia: a randomized controlled trial. Gastrointest Endosc 2024; 99: 1-9
• 73 Li C, Gong A, Zhang J. et al. Clinical outcomes and safety of partial full-thickness myotomy versus circular muscle myotomy in peroral endoscopic myotomy for achalasia patients. Gastroenterol Res Pract 2017; 2017: 2676513
• 74 Li QL, Chen WF, Zhou PH. et al. Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy. J Am Coll Surg 2013; 217: 442-451
• 75 Kumbhari V, Familiari P, Bjerregaard NC. et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 2017; 49: 634-642
• 76 Duan T, Tan Y, Zhou J. et al. A retrospective study of peroral endoscopic full-thickness myotomy in patients with severe achalasia. J Laparoendosc Adv Surg Tech A 2017; 27: 770-776
• 77 Wang XH, Tan YY, Zhu HY. et al. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease. World J Gastroenterol 2016; 22: 9419-9426
• 78 Mota RCL, de Moura EGH, de Moura DTH. et al. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc 2021; 35: 383-397
• 79 Zhang H, Zeng X, Huang S. et al. Safety and efficacy of peroral endoscopic shorter myotomy versus longer myotomy for patients with achalasia: a systematic review and meta-analysis. Gastroenterol Res Pract 2022; 2022: 6770864
• 80 Familiari P, Borrelli de Andreis F, Landi R. et al. Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority controlled trial. Gut 2023; 72: 1442-1450
• 81 Nabi Z, Ramchandani M, Sayyed M. et al. Comparison of short versus long esophageal myotomy in cases with idiopathic achalasia: a randomized controlled trial. J Neurogastroenterol Motil 2021; 27: 63-70
• 82 Gu L, Ouyang Z, Lv L. et al. Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial. Gastrointest Endosc 2021; 93: 1304-1312
• 83 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-I patients with achalasia: a randomized clinical trial. JAMA 2019; 322: 134-144
• 84 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. NEJM 2019; 381: 2219-2229
• 85 Knight W, Kandiah K, Vrakopoulou Z. et al. Early outcomes following EndoFLIP-tailored peroral endoscopic myotomy (POEM): the establishment of POEM services in two UK centers. Dis Esophagus 2023; 36: doac110
• 86 Yoo IK, Choi SA, Kim WH. et al. Assessment of clinical outcomes after peroral endoscopic myotomy via esophageal distensibility measurements with the endoluminal functional lumen imaging probe. Gut Liver 2019; 13: 32-39
• 87 Kane ED, Budhraja V, Desilets DJ. et al. Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia. Surg Endosc 2019; 33: 886-894
• 88 Khashab MA, Familiari P, Draganov PV. et al. Peroral endoscopic myotomy is effective and safe in non-achalasia esophageal motility disorders: an international multicenter study. Endosc Int Open 2018; 6: E1031-E1036
• 89 Zhang LY, Bejjani M, Ghandour B. et al. Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites. Endoscopy 2023; 55: 186-191
• 90 Ullah S, Yang S. Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites: not yet there. Endoscopy 2023; 55: 394
• 91 Pescarus R, Shlomovitz E, Sharata AM. et al. Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case-control study. Surg Endosc 2016; 30: 2132-2135
• 92 Hernandez Mondragon OV, Gutierrez-Aguilar R, Garcia Contreras LF. et al. Conventional clips vs over-the-scope-clips for the closure of the entry site in POEM and G-POEM procedures. Rev Esp Enferm Dig 2020; 112: 338-342
• 93 Li Q-L, Zhou P-H, Yao L-Q. et al. Early diagnosis and management of delayed bleeding in the submucosal tunnel after peroral endoscopic myotomy for achalasia (with video). Gastrointest Endosc 2013; 78: 370-374
• 94 Nabi Z, Chavan R, Ramchandani M. et al. Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique. VideoGIE 2022; 7: 158-163
• 95 Wang Y, Liu Z-Q, Xu M-D. et al. Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc 2019; 89: 769-778
• 96 Zhang X-C, Li Q-L, Xu M-D. et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy 2016; 48: 967-978
• 97 Yeniova AÖ, Yoo IK, Cho JY. Mucosal injury during per-oral endoscopic myotomy: a single-center experience. Turk J Gastroenterol 2022; 33: 985-994
• 98 Gonzalez J-M, Benezech A, Barthet M. Complications of submucosal endoscopy. Best Pract Res Clin Gastroenterol 2016; 30: 783-791
• 99 Modayil R, Friedel D, Stavropoulos SN. Endoscopic suture repair of a large mucosal perforation during peroral endoscopic myotomy for treatment of achalasia. Gastrointest Endosc 2014; 80: 1169-1170
• 100 Crespin OM, Liu LWC, Parmar A. et al. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc 2017; 31: 2187-2201
• 101 Liu X, Yao L, Cheng J. et al. Landscape of adverse events related to peroral endoscopic myotomy in 3,135 patients and a risk-scoring system to predict major adverse events. Clin Gastroenterol Hepatol 2021; 19: 1959-1966.e3
• 102 Darisetty S, Nabi Z, Ramchandani M. et al. Anesthesia in per-oral endoscopic myotomy: A large tertiary care centre experience. Indian J Gastroenterol 2017; 36: 305-312
• 103 Chiapponi C, Stocker U, Körner M. et al. Emergency percutaneous needle decompression for tension pneumoperitoneum. BMC Gastroenterol 2011; 11: 48
• 104 Paspatis GA, Arvanitakis M, Dumonceau J-M. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020. Endoscopy 2020; 52: 792-810
• 105 Nabi Z, Ramchandani M, Chavan R. et al. Double tunnel technique reduces technical failure during POEM in cases with severe submucosal fibrosis. Endosc Int Open 2021; 9: E1335-E1341
• 106 Li Y, LingHu E, Ding H. et al. Peroral endoscopic myotomy with simultaneous submucosal and muscle dissection for achalasia with severe interlayer adhesions. Gastrointest Endosc 2016; 83: 651-652
• 107 Feng J, Chai N, Zhang W. et al. Long-term outcomes of peroral endoscopic myotomy with simultaneous submucosal and muscle dissection (POEM-SSMD) for achalasia with severe interlayer adhesions. Chin Med J (Engl) 2022; 135: 724-726
• 108 Philips GM, Dacha S, Keilin SA. et al. Concurrent myotomy and tunneling after establishment of a half tunnel instead of myotomy after establishment of a full tunnel: a more efficient method of peroral endoscopic myotomy. Endosc Int Open 2016; 4: E403-E408
• 109 Lin Y-J, Liu S-Z, Li L-S. et al. Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia. World J Gastroenterol 2023; 29: 2349-2358
• 110 Liu W, Zeng H-Z, Chen H-L. et al. Open peroral endoscopic myotomy (O-POEM) for the treatment of achalasia. Dis Esophagus 2017; 30: 1-2
• 111 Tan Y, Li C, Yan J. et al. Difficult peroral endoscopic myotomy: definition and management strategies. Expert Rev Gastroenterol Hepatol 2019; 13: 933-942
• 112 Shiwaku H, Inoue H, Yamashita K. et al. Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first over 100 patients with short-term follow-up. Surg Endosc 2016; 30: 4817-4826
• 113 Misra L, Fukami N, Nikolic K. et al. Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician. Med Devices (Auckl) 2017; 10: 53-59
• 114 Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 2018; 87: 4-17
• 115 Ujiki MB, Yetasook AK, Zapf M. et al. Peroral endoscopic myotomy: A short-term comparison with the standard laparoscopic approach. Surgery 2013; 154: 893-897 ; discussion 897–900
• 116 Elmunzer BJ, Lewis BR, Miller KF. et al. Paravertebral anesthetic nerve block for pain control after peroral endoscopic myotomy. Tech Innov Gastrointest Endosc 2021; 23: 297-303
• 117 Rai M, Nazarin A, Taylor C. et al. A randomized controlled pilot study of topical ropivacaine for prevention of post-POEM pain. J Can Assoc Gastroenterol 2022; 5: 221-225
• 118 Xie G, Li S, Zeng M. et al. Oxycodone is superior to morphine for pain relief following peroral oesophageal myotomy: a prospective, randomized, controlled trial. Wideochir Inne Tech Maloinwazyjne 2022; 17: 624-633
• 119 Sternbach JM, El Khoury R, Teitelbaum EN. et al. Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 2015; 158: 1128-1135 ; discussion 1135–1136
• 120 DeWitt JM, Siwiec RM, Perkins A. et al. Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response. Endosc Int Open 2021; 9: E1692-E1701
• 121 Pannu D, Yang D, Abbitt PL. et al. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc 2016; 84: 408-415
• 122 Cai M-Y, Zhou P-H, Yao L-Q. et al. Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia. Gastrointest Endosc 2014; 80: 1046-1055
• 123 Barret M, Dohan A, Oudjit A. et al. Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay. Eur Radiol 2020; 30: 4175-4181
• 124 Chartier M, Barat M, Dohan A. et al. Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders. Endosc Int Open 2021; 9: E1355-E1360
• 125 El Khoury R, Teitelbaum EN, Sternbach JM. et al. Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM). Surg Endosc 2016; 30: 2969-2974
• 126 Yang S, Zeng M-S, Zhang Z-Y. et al. Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications?. Acta Radiol 2015; 56: 1216-1221
• 127 Levy JL, Levine MS, Rubesin SE. et al. Findings of esophagography for 25 patients after peroral endoscopic myotomy for achalasia. AJR Am J Roentgenol 2016; 207: 1185-1193
• 128 Lemmens J, Klarenbeek B, Verstegen M. et al. Performance of a consensus-based algorithm for diagnosing anastomotic leak after minimally invasive esophagectomy for esophageal cancer. Dis Esophagus 2023; 36: doad016
• 129 Benias PC, Korrapati P, Raphael KL. et al. Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge. Gastrointest Endosc 2019; 90: 570-578
• 130 Cloutier Z, Mann A, Doumouras AG. et al. Same-day discharge is safe and feasible following POEM surgery for esophageal motility disorders. Surg Endosc 2021; 35: 3398-3404
• 131 Fujiyoshi Y, Inoue H, Abad MRA. et al. Importance of second-look endoscopy after per-oral endoscopic myotomy for safe postoperative management. Dig Endosc 2021; 33: 364-372
• 132 Repici A, Fuccio L, Maselli R. et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 2018; 87: 934-943.e18
• 133 Al Lehibi A, Elkholy S, Gouda M. et al. Peroral endoscopic myotomy (POEM) for the treatment of achalasia: A multicenter Middle Eastern experience. Saudi J Gastroenterol 2022; 28: 74-79
• 134 Ching Hui Yee C, Youssef M, Woo M. et al. Peroral endoscopic myotomy for complex achalasia and the POEM difficulty score: An update. DEN Open 2025; 5: e70055