Correspondence to Author: Pipul Poudel, Krishal Adhikari, Arpana Khanal, Anastasia Thapa Magar, Roshim Shrestha, Faiza Ahmed, Endrit Shahini, Mohamad Mouchli, Basile Njei. 

Pipul Poudel: Medical Officer, Ristimadi Hospital, Lamjung, Nepal
Krishal Adhikari: Medical Officer, Chitwan Medical College, Bharatpur-10, Chitwan
Anastasia Thapa Magar: Medical Officer, Chitwan Medical College, Bharatpur-10, Chitwan
Arpana Khanal: Medical Officer, Dreamskin aesthetic, Butwal, Nepal
Roshim Shrestha: Medical Officer, Chitwan Medical College, Bharatpur-10, Chitwan
Faiza Ahmed: Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida, United States of America.
Endrit Shahini: Gastroenterology Unit, National Institute of Gastroenterology-IRCCS "Saverio de Bellis", Castellana Grotte, Bari, Italy.
Mohamad Mouchli: Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America.
Basile Njei: Division of Digestive Diseases, International Medicine Program (Section of Digestive Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.

Abstract:

Background: Achalasia cardia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of esophageal peristalsis. Traditional therapies, including pneumatic dilation and laparoscopic Heller myotomy (LHM), offer symptom relief but carry limitations regarding durability and postoperative reflux. Peroral Endoscopic Myotomy (POEM), first introduced in 2008, has revolutionized management through a minimally invasive natural orifice transluminal endoscopic approach.
Objective: To review the current evidence on indications, safety, efficacy, and long-term outcomes of POEM in adult achalasia patients, and to compare its performance with conventional therapies.
Methods: A narrative synthesis of published randomized trials, meta-analyses, and large multicenter studies was performed, focusing on clinical success, manometric outcomes, and adverse event profiles of POEM.
Results: Across major series, POEM achieved >90% clinical success with sustained symptom remission beyond 5–7 years. Significant reductions in LES pressure (20–30 mmHg) were consistently demonstrated. The pooled adverse event rate was 7.5%, with most complications being minor and conservatively managed. Compared to LHM, POEM showed equivalent efficacy and safety with shorter operative time, less blood loss, and faster recovery. However, postoperative reflux occurred in up to 50% of cases, though mostly controlled with proton pump inhibitors.
Conclusion: POEM is an established, safe, and durable treatment for achalasia, offering superior symptom relief and quality-of-life improvement with minimal invasiveness. Its expanding indications to complex and spastic motility disorders, along with comparable long-term efficacy to surgical myotomy, affirm its role as the preferred therapeutic modality for adult achalasia..

Citation:

Dr.Faiza Ahmed, Peroral Endoscopic Myotomy (Poem) As A Safe, Effective, And Durable Therapy For Adult Achalasia. Japanese Journal of Gastroenterology 2026.