Endoscopy 2010; 42(4): 265-271
DOI: 10.1055/s-0029-1244080
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Peroral endoscopic myotomy (POEM) for esophageal achalasia[*]

H.  Inoue1 , H.  Minami1 , Y.  Kobayashi1 , Y.  Sato1 , M.  Kaga1 , M.  Suzuki1 , H.  Satodate1 , N.  Odaka1 , H.  Itoh1 , S.  Kudo1
  • 1Digestive Disease Center, Showa University Northern Yokohama Hospital
Further Information

Publication History

submitted 22 February 2010

accepted after revision 5 March 2010

Publication Date:
30 March 2010 (online)

Background: Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia.

Patients and methods: POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastroesophageal junction was confirmed at the end of the procedure.

Results: In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs).

Conclusions: The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited.

1 These results were reported at DDW 2009 in Chicago (2 June 2009) and at UEGW 2009 in London (25 November 2009).


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1 These results were reported at DDW 2009 in Chicago (2 June 2009) and at UEGW 2009 in London (25 November 2009).

H. Inoue

Showa University Northern Yokohama Hospital
Digestive Disease Center

Chigasaki-Chuo 35-1, Tsuzuki-ku
Yokohama 224-8503

Fax: +81-45-949-7927

Email: haruinoue777@yahoo.co.jp