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Preface; Contents; Contributors; 1: Introduction: Endoscopic Submucosal Dissection to Per Oral Endoscopic Myotomy (POEM); Introduction; Endoscopic Mucosal Resection (EMR); Strip Biopsy; Band Ligation; Evolution of the Distal Cap; Large-Volume Injection; Endoscopic Submucosal Dissection (ESD); From EMR to ESD; Evolution of Knives; Submucosal Tunneling; POEM; Experimental Endoscopic Myotomy; Early Experience with Human POEM; Summary and Future Trends; References; 2: POEM: Concept to Research Laboratory; Introduction; History of Achalasia Therapy; Pathophysiology; Early Endoscopic Myotomy.

Chest Pain Heartburn; Weight Loss; Symptom Scores; Past Medical History; Diagnostic Evaluation; Upper Endoscopy; Contrast Esophagram; Esophageal Manometry; Ambulatory pH Monitoring; Expanded Indications; References; 5: Clinical Introduction of POEM for Achalasia: Technique; Introduction; Preoperative Patient Preparation; Preoperative Operating Room Preparation; Intraoperative Patient and Staff Preparation; Operative Technique; Commentary; References; 6: Technical Modifications for Motility Disorders: Dimensions of Dissection; Introduction; Preoperative Evaluation; Manometry.

High-Resolution Manometry Analysis The Chicago Classification; Achalasia; Outflow Obstruction; Esophageal Motor Dysfunctions; POEM Technique; Mapping EGD; Dissection of the Submucosal Tunnel; Myotomy and Closure; EndoFLIP; Extended Criteria; Hypertensive Motor Disorders; End-Stage Achalasia; Previous Endoscopic and Surgical Interventions; POEM in the Pediatric Population; POEM in the Obese Population; References; 7: POEM Contraindications and Pitfalls; Introduction; POEM Contraindications and Pitfalls in Patient Selection; POEM Contraindication Due to Comorbidities.

Patients in Whom POEM May Not Represent Appropriate Therapy Procedural Pitfalls; Preprocedure Preparation; Tunnel Initiation and Orientation; Initial Submucosal Injection; Initial Mucosal Incision; Initial Entry into the Submucosal Space and Tunnel Initiation; Submucosal Tunnel Dissection; Myotomy; Closure of the Submucosal Tunnel; References; 8: Learning Curve and Initial Outcomes; Introduction; Early Outcomes; Learning Curve; Measuring EGJ Distensibility During POEM; References; 9: Comparative Outcomes: POEM Versus Balloons, Botox, and Surgical Myotomy; References.

Third Space Endoscopy Technical Maturation; Future Trends; References; 3: Current and Emerging Instruments and Energy; Introduction; Devices for POEM; Endoscopes; Overtubes; Gas Insufflation; Knives; Electrosurgical Units (ESU); Hemostatic Forceps; Adjuvant Tools for Tissue Retraction and Enhanced Visualization; Injection Agents and Devices; Biliary Extraction Balloon; Mucosal Closure Devices; Summary; References; 4: Indications and Preoperative Workup for Peroral Endoscopic Myotomy; Peroral Endoscopic Myotomy; Achalasia; Symptom Evaluation; Dysphagia; Regurgitation.

This text is designed to present a comprehensive and state-of the-art approach to the current and future status of POEM. Sections address preliminary issues faced by surgeons and gastroenterologists who are interested in implementing this procedure into their treatment armamentarium. These areas include the evolution of the technique, training and credentialing, as well as tools and platforms commonly used for POEM. Subsequent chapters focus on specific disease processes, and future applications of the technique. Written by experts in POEM, Per Oral Endoscopic Myotomy (POEM) addresses patient selection, pre-operative considerations, technique, and avoiding complications. A brief editorial review of the existing literature addressing the particular topic follows in each section. The text concludes with chapters on emerging and future applications. Extensive endoscopic images and illustrations make this an interactive text for General Surgeons, Surgical Endoscopists, Gastroenterologists, and associated sub-specialists.