POEM: Efficacy, Safety, Training, and Competency

Peroral endoscopic myotomy (POEM) is the endoscopic approach of surgical myotomy for patients with spastic esophageal disorders. A submucosal esophago-cardial tunnel is created as an operating space, and an endoscopic myotomy is carried out by means of a micro-knife and the tunnel subsequently closed by clips. Due to its minimally invasive character, it appears to be effective and safe even in old or multimorbid patients, regardless of prior therapy undertaken. POEM and balloon dilation have replaced other endoscopic treatment modalities such as intersphincteric botulinum toxin A injection. Multiple studies during the last 5 years have proven the clinical value of POEM. However, the POEM procedure can be a challenge for even advanced endoscopists. Serious adverse events can arise, and endoscopists starting with POEM should be well trained to handle these complications and avoid open surgery. Potential complications include bleeding, perforation, pneumothorax, pneumomediastinum, pneumoperitoneum, as well as infections such as mediastinitis and abscess formation. With this chapter, we would like to give a short overview on efficacy, safety, training, and competency in POEM.