Critical Decision-Making: Technical Aspects of Performing POEM

Achalasia has become increasingly diagnosed in the last decade and has become an important therapeutic entity for advanced endoscopists since the advent of PerOral Endoscopic Myotomy (POEM). This treatment now provides a highly successful minimally-invasive approach which, for most patients, is an outpatient procedure. Consistent success depends on patient selection, sound technique and management of infrequent adverse events . This article focusses on these three areas and hopes to assist referring gastroenterologists in understanding the appropriateness of POEM for achalasia and to guide those endoscopists embarking on a POEM program in making decisons.