ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One) | March 2026-Third-space Endoscopy- POEM, G-POEM, and Z-POEM Innovative Approaches and Case Insights

Third-space Endoscopy- POEM, G-POEM, and Z-POEM Innovative Approaches and Case Insights

Video Transcription

Video Summary

The speaker reviews “third space endoscopy,” where an endoscopist makes a mucosal incision and tunnels into the submucosa to perform therapeutic interventions such as myotomy. They compare three related procedures: POEM (for achalasia, cutting the lower esophageal sphincter), G-POEM (for gastroparesis, cutting the pylorus), and Z-POEM (for Zenker’s diverticulum, cutting the cricopharyngeal muscle).<br /><br />A case of progressive dysphagia highlights that high-resolution esophageal manometry is the gold standard for diagnosing achalasia, with endoscopy and esophagram (bird-beak) as supportive tests. Management options include Botox, dilation, Heller myotomy, and POEM; POEM and Heller are similarly effective, but POEM has more reflux risk, often requiring prolonged PPI therapy.<br /><br />For gastroparesis, diagnosis includes EGD and gastric emptying scan; G-POEM is considered after dietary/medication failure and has similar efficacy to pyloroplasty with shorter stays. Zenker’s is diagnosed by barium studies; Z-POEM has high success. The talk emphasizes APP roles in workup, counseling, and follow-up.

Asset Subtitle

Katelyn Cookson, PA-C

Keywords

third space endoscopy

peroral endoscopic myotomy (POEM)

achalasia diagnosis and management

G-POEM for gastroparesis

Z-POEM for Zenker's diverticulum

high-resolution esophageal manometry