Per-Oral Endoscopic Myotomy (POEM): A Paradigm Shift in Achalasia Therapy

Abstract

Achalasia of the cardia, a rare esophageal motility disorder, poses significant challenges in management due to its progressive nature and debilitating symptoms. Per-Oral Endoscopic Myotomy (POEM) has emerged as a groundbreaking minimally invasive technique, offering a promising alternative to traditional surgical interventions such as Heller myotomy and pneumatic dilation. This review explores the role of POEM in the management of achalasia, focusing on its efficacy, safety profile, and long-term outcomes. Key topics include an overview of the pathophysiology of achalasia, the technical advancements underpinning POEM, and comparative analysis with established therapeutic modalities. Current evidence suggests that POEM provides excellent symptom relief, with high success rates across all subtypes of achalasia, and demonstrates favorable outcomes even in challenging cases such as failed prior interventions. Complications, such as gastroesophageal reflux disease (GERD), and their management strategies are discussed in detail. By synthesizing recent data and clinical experiences, this review highlights the transformative impact of POEM in reshaping the therapeutic landscape of achalasia, emphasizing its potential as a first-line treatment in select patient populations.