2021 TDDW
Symposium (I) THIRD SPACE ENDOSCOPY – 2021 UPDATE
POEM FOR ESOPHAGEAL MOTILITY DISEASE. WHO, WHEN AND HOW? Yin-Yi Chu Ultrasonography and Endoscopy Center, New Taipei Municipal Tuchen Hospital, New Taipei City, Taiwan Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan High-resolution manometry is now the gold standard diagnostic tool for esophageal motility diseases, which classified on the basis of lower esophageal sphincter (LES) relaxation and motility of esophageal body: (1) incomplete LES relaxation, including achalasia and EGJ outflow obstruction; (2) major motility disorders, including absent contractility, distal esophageal spasm etc.; (3) minor motility disorders; (4) normal esophageal motility. Third space endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The era of third space endoscopy started
with peroral endoscopic myotomy (POEM) for treatment of achalasia and has expanded to treat various other gastrointestinal disorders. This topic focus on POEM application to various esophageal motility diseases, (1) the indications of POEM, including non-achalasia spastic esophageal motility disorders, the extreme of age and failed previous treatment of achalasia, (2) advancements in procedural techniques such as detection of EGJ and adequacy myotomy, length and site of myotomy, full thickness or circular myotomy, (3) the effectiveness, outcomes and advers events of POEM. Up to now, POEM is rapidly emerging as minimally invasive alternatives to conventional surgery.
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