SAGES guidelines for the use of peroral endoscopic myotomy (POEM) for the treatment of achalasia

Geoffrey P Kohn, Rebecca C Dirks, Mohammed T Ansari, Jason Clay, Christy M Dunst, Lars Lundell, Jeffrey M Marks, Daniela Molena, Ceciel Rooker, Payal Saxena, Lee Swanstrom, Reuben K Wong, Aurora D Pryor, Dimitrios Stefanidis
Surgical Endoscopy 2021, 35 (5): 1931-1948

BACKGROUND: Peroral endoscopic myotomy (POEM) is increasingly used as primary treatment for esophageal achalasia, in place of the options such as Heller myotomy (HM) and pneumatic dilatation (PD) OBJECTIVE: These evidence-based guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) intend to support clinicians, patients and others in decisions about the use of POEM for treatment of achalasia.

RESULTS: The panel agreed on 4 recommendations for adults and children with achalasia.

CONCLUSIONS: Strong recommendation for the use of POEM over PD was issued unless the concern of continued postoperative PPI use remains a key decision-making concern to the patient. Conditional recommendations included the option of using either POEM or HM with fundoplication to treat achalasia, and favored POEM over HM for achalasia subtype III.

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