HOW TO INTRODUCE PERORAL ENDOSCOPIC MYOTOMY(POEM)?~INSTITUTIONAL STANDARDS OF POEM AND START-UP ISSUES~

Abstract

Esophageal achalasia is one of the most common esophageal motility disorders. When peroral endoscopic myotomy (POEM) was invented, it became popular worldwide as a minimally invasive alternative to Heller myotomy. While POEM is an excellent and effective endoscopic treatment, its novelty brings about several problems during starting up in each hospital. In addition to clinical issues, such as the rarity of esophageal achalasia, there are also systemic issues involved, such as institutional standards for medical insurance, which make it difficult to initiate POEM. Neither of these problems are easy to overcome, but POEM is a very rewarding treatment for endoscopists, as symptoms often improve dramatically. In addition, POEM is an excellent procedure that has the potential to develop into a variety of new treatments, so it is important to overcome these problems and start it up.