Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute

Peter J. Kahrilas, David A Katzka, Joel E. Richter

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20−40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure.

Original languageEnglish (US)
Pages (from-to)1205-1211
Number of pages7
JournalGastroenterology
Volume153
Issue number5
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Fingerprint

Esophageal Achalasia
Practice Guidelines
Therapeutics
Peptic Esophagitis
Proton Pump Inhibitors
Expert Testimony
PubMed
Mental Competency
Endoscopy
Publications
Comorbidity
Physicians

Keywords

  • Achalasia
  • Esophageal Motility Disorders
  • High-Resolution Manometry
  • Per-Oral Endoscopic Myotomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical Practice Update : The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute. / Kahrilas, Peter J.; Katzka, David A; Richter, Joel E.

In: Gastroenterology, Vol. 153, No. 5, 01.11.2017, p. 1205-1211.

Research output: Contribution to journalReview article

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