A step-by-step walk through this emerging MIS procedure
Laparoscopic Heller myotomy is the standard of care for treating achalasia, but interest is mounting around the emerging minimally invasive technique of per oral endoscopic myotomy (POEM) for achalasia, particularly after failed Heller myotomy.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
In this video, Cleveland Clinic thoracic surgeon Siva Raja, MD, PhD, walks us step by step through the POEM procedure after failed Heller myotomy using a wealth of intraoperative endoscopic video footage. Along the way he shares expert advice on maneuvers to overcome scarring, how to deal with perforations and other practical considerations.
“POEM after failed Heller myotomy is safe, with minimal morbidity and excellent short-term palliation,” says Dr. Raja. “Because this is a relatively new technology, long-term data are not yet available, but we look forward to the emergence of those data in the coming years.”
Careful risk stratification is key
Findings support the safety of the technique
Insights from murine models could help guide care for patients
Reviewing how the drug can be incorporated into care
Insights on guiding treatment decisions
Largest, longest analysis to date shows greater weight loss and fewer diabetes medications needed
Strong patient communication can help clinicians choose the best treatment option
ctDNA should be incorporated into care to help stratify risk pre-operatively and for post-operative surveillance