Peroral Endoscopic Myotomy (POEM) for the Treatment of Achalasia

Achalasia is a chronic disease of altered esophageal motility with resulting functional
obstruction to the passage of food leading to poor quality of life and significant morbidity.
The two main treatments available in the US are endoscopic balloon dilation and surgical
myotomy. Each therapy has advantages and drawbacks and at present both are considered a first
choice approach depending on patient preferences and local expertise. Surgical myotomy
provides long lasting improvement in dysphagia but even when done laparoscopically is
invasive and complex. Extensive acid reflux resulting in significant morbidity is routinely
seen after surgical myotomy and additional anti-reflux operation is typically done at the
time of the myotomy. Endoscopic balloon dilation is a simple minimally invasive outpatient
procedure but improvement of symptoms tends to be shorter in duration and repeat dilations
are commonly needed. Both therapies improve on dysphagia but tend to provide suboptimal
control of chest pain which is one of the cardinal symptoms of achalasia.

The peroral endoscopic myotomy (POEM) was first introduced in Japan to address the suboptimal
results with endoscopic balloon dilation and surgical myotomy. POEM is incisionless minimally
invasive but in addition may have some further advantages over surgical myotomy including
unlimited length of the myotomy with expected better control of chest pain and preservation
of the anatomical anti-reflux barrier (angle of His and the cruse of the diaphragm) with
expected lower incidence of acid reflux.

In Japan POEM has become the preferred modality for therapy of achalasia due to the excellent
results and exceptional safety record. In the US, dedicated POEM devices were approved by the
FDA just recently. As a result the bulk of the published data comes from Japan and very
little is known regarding outcomes in US population. Therefore the investigators want to
prospectively record our experience with POEM as done as part of routine medical care in US
population. This will be a data recording study. All patients will receive standard medical
care and no experimental interventions will be performed.