What do you think of the Long Term POEM success?
There is little long-term data. So far, we know that a significant amount of patients develop severe reflux esophagitis and stricturing esophageal disease. I still think that POEM is a good alternative for patients who are poor surgical candidates, but am still not 100% convinced that it's the only therapy for achalasia, especially with much more long-term data from surgical interventions such as Heller myotomy.
Peroral endoscopic myotomy (POEM). POEM is one the most significant progresses in interventional gastrointestinal endoscopy. The elemental concept of POEM is the performance of endoscopy between the muscle layer and the submucosa. As endoscopy is not performed endoluminally nor in the Peritoneum, pleural or mediastinal spaces it is properly called “third-space endoscopy” or submucosal tunneling pro- cedure. The figure shows the essential steps for POEM, including proper creation of a submucosal cushion, incision of the mucosa and submu- cosa, endoscopic dissection and tunneling through the submucosal layer and final endoscopic myotomy. As expected submucosal tunneling techniques are also useful to perform resection of submucosal and muscular tumors per-oral endoscpic tumor excision (POET) and submucosal tunneling endoscopic resection (STER).