ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: (On-Demand) | July 2022-Draganov

Draganov - POEM Tool Box and Methods

Pdf Summary

This document discusses the toolbox and techniques used in endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) procedures. The toolbox includes an endoscope with a water jet and a distal attachment (cap). Insufflation must be done using carbon dioxide, and an injection solution of saline with dye is used. Various types of electrosurgical equipment and needle type knives are also used. The techniques discussed include mucosal incision, closure of the incision using clips, suturing, X-tack, OTSC, or stent, and the direction and orientation of the myotomy. The "adequate" myotomy is defined by factors such as relief of dysphagia and GERD. The document explores the differences between anterior and posterior myotomy and full thickness versus circular (selective) versus partial full thickness myotomy. It also discusses the optimal length of the myotomy in the esophagus and the cardia. Studies comparing the outcomes of different techniques are referenced. The document concludes by highlighting the need for a dedicated toolbox for POEM and the ongoing efforts to refine techniques to reduce post-POEM GERD while maintaining clinical efficacy.

Keywords

endoscopic submucosal dissection

peroral endoscopic myotomy

toolbox

endoscope

water jet

carbon dioxide insufflation

electrosurgical equipment

mucosal incision

myotomy direction

GERD relief