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The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.
Laparoscopic myotomies have shorter recovery times, reduced postoperative pain, and lower chances of complications. Endoscopic Myotomy (POEM): Peroral endoscopic myotomy, or POEM, is a recent technique for achalasia that is entirely endoscopic, eliminating the need for external incisions.
Heller myotomy is a surgical procedure [1] in which the muscles of the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach.It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esophagus .
If symptoms are severe or persistent, peroral endoscopic myotomy (POEM) may be offered. [2] Pneumatic dilation may be used for persistent symptoms in the absence of identified causes of mechanical obstruction. [2] Botulinum toxin may be considered, [5] especially for individuals who are unlikely to tolerate surgery. [2]
Nutcracker esophagus, jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.
Advanced achalasia is characterized by regurgitation of previously swallowed, undigested food material. Individuals with diffuse esophageal spasm or nutcracker esophagus, due to disordered peristalsis propagation, may experience severe chest pain and dysphagia, mimicking cardiac ischemia. [3]
achalasia; Zenker's diverticulum; a barium swallow may be performed before endoscopy to help identify abnormalities that might increase the risk of perforation at the time of endoscopy. If achalasia suspected an upper endoscopy is required to exclude a malignancy as a cause of the findings on barium swallow. Manometry is performed next to confirm.