| Theme |
Endoscopic Practice Based on Guidelines |
| Title |
Clinical Practice Guidelines for Peroral Endoscopic Myotomy |
| Author |
Hironari Shiwaku |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| Author |
Hiroki Okada |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| Author |
Tomoe Masui |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| Author |
Toshihiro Omiya |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| Author |
Kanefumi Yamashita |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| Author |
Hitomi Minami |
Department of Gastroenterology and Hepatology, Nagasaki University Hospital |
| Author |
Haruhiro Inoue |
Digestive Diseases Center, Showa University Koto‒Toyosu Hospital |
| Author |
Suguru Hasegawa |
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine |
| [ Summary ] |
Achalasia is a functional motility disorder of the esophagus. It is characterized by incomplete lower esophageal sphincter (LES) relaxation and aperistalsis of the esophagus. Peroral endoscopic myotomy (POEM) is a standard treatment for achalasia that was reported in 2008 by Inoue and colleagues. It is less invasive and has a higher curative effect compared with conventional therapeutic methods for achalasia. In this article, we will introduce and describe the first guidelines for peroral endoscopic myotomy, reporting our clinical experience.
Endoscopy, barium swallow examination, manometry, and computed tomography (CT) are performed to diagnose esophageal achalasia. Risk assessment for general anesthesia is also conducted. POEM is performed under general anesthesia with endotracheal intubation and CO2 insufflation. Air insufflation should never be used. To determine the length of myotomy, the affected part of the esophageal body that is responsible for the patient's symptom is identified based on information gained from patient interviews, esophagography, upper gastrointestinal endoscopy, and esophageal manometry. Myotomy is performed from the oral side of the affected part in the esophageal body to 2 cm into the stomach side to secure incision of the LES. The double‒scope method of POEM in which a second endoscope is inserted to obtain a retroflexed view of the gastric cardia is particularly useful because it allows direct visualization to verify that the myotomy extends down to the stomach. |