PEP: panesophageal pressurization; LES: lower esophageal sphincter; ASA: American Society of Anesthesiologists; GERD: gastroesophageal reflux disease; POEM: peroral endoscopic myotomy; SL: sublingual.
* The preprocedure evaluation includes a medical history, anesthesia-directed physical examination, and assessing ASA physical status. Refer to UpToDate content on anesthesia for gastrointestinal endoscopy for details.
¶ Higher rates of GERD are reported after POEM than either laparoscopic myotomy or pneumatic dilation. This may be a consideration for younger patients and for those who do not want long-term therapy with a proton pump inhibitor.
Δ The length of the myotomy can be tailored to the length of the spastic esophageal segment as demonstrated on diagnostic studies (eg, high resolution manometry, functional lumen imaging probe).