Post written by Hironari Shiwaku, MD, PhD, from the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

Peroral endoscopic myotomy (POEM) is a standard treatment for achalasia. The reported efficacy of POEM in the prospective multicenter study by Dr Von Renteln’s group was 82%. However, a retrospective multicenter study in Japan reported a higher efficacy rate of 95%. The aim of this study was to prospectively verify treatment outcomes after POEM at multiple facilities in Japan. The results showed an efficacy rate at 3 months and 1 year after POEM to be 97.1% and 97.4%. From this result, our prospective multicenter study in Japan showed greater efficacy of POEM for achalasia compared with the results of a previous prospective multicenter study. POEM is highly effective for at least 1 year.

There had only been one prospective study of POEM so far. The result of which was not good compared with our results in Japan. POEM is one of the standard treatments for achalasia. The results and message of this prospective study are very important for POEM in becoming the first-line treatment for achalasia all over the world.

The following two points are very important to keep high efficacy.

1) Educating the operator of POEM.

2) Recognizing LES part objectively (we recommend performing the double-scope method).

Figure 3. Efficacy rates 3 months and 1 year after peroral endoscopic myotomy in this study compared with a previous prospective study.

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