Video demonstration of successful per oral endoscopic myotomy with key technical considerations

Smita Sihag, MD, David W Rattner, MD, Ozanan R Meireles, MD. Massachusetts General Hospital.

Per oral endoscopic myotomy (POEM) still represents a novel procedure that more and more high-volume centers are seeking approval to perform for the treatment of achalasia. Here, we present a video demonstration of a successfully completed POEM at our center. In particular, we clearly illustrate each of the four major steps of the procedure: 1) the mucosotomy, 2) submucosal dissection, 3) myotomy, and 4) mucosal closure, with a number of key technical considerations including what we call the ‘critical view’ of the myotomy in order to avoid full thickness injury to the esophagus. We believe this demonstration may be helpful to other minimally invasive surgeons and advanced endoscopists that are interested in POEM.  

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