Practice Variation Exists In The Performance Of Per Oral Endoscopic Myotomy (Poem): Results Of An International Survey Of Poem Experts

Aims POEM for the treatment of achalasia was introduced by Inuoe in 2010. Since then, POEM has been widely adopted internationally. However, until now, there are no international “guidelines” on best practices for POEM. We aimed to assess potential practice variations amongst international POEM experts.

Methods An online survey asking detailed questions on pre-POEM, intra-POEM and post-POEM procedure related practice and patient management was sent to POEM experts. Experts were identified through a comprehensive literature search.

Results Two hundred and sixty-five POEM experts were identified and contacted by email. Eighty-five (32.1 %) experts (60 GIs, 25 surgeons) responded. Of these, 53 % reported performing POEM for more than 5 years, however, 29.3 % had performed less than 50 POEMs and only 7.3 % had performed more than 500 POEM procedures. 79.3 % performed POEM for a non-achalasia indication (e.g., DES, Jackhammer). Posterior myotomy was the preferred endoscopic approach (56.1 %) and the triangle tip knife was used by 58.5 %. A proximal to distal myotomy, standard length of myotomy (6cm above GEJ) and preservation of the longitudinal muscles was reported by 91.5 %, 41.46 % and 75.6 %, respectively. We found that 64.6 % performed a 2cm myotomy extension into the cardia and 97.6 % prescribe prophylactic antibiotics peri-procedure. The most common diathermy settings used for myotomy were “endocut” (53.8 %) and “spray coagulation” (28.8 %). Post-POEM, 53.8 % and 40.0 % of respondents admit patients to hospital for one or two nights, respectively. Only 55.0 % routinely perform a barium/gastrograffin study and 16.0 % do not prescribe PPI.

Conclusions POEM has rapidly gained worldwide popularity. However, our survey of POEM experts identified significant variation in POEM practices. An international study group is needed to better define and provide guidance on best practices in POEM.

Citation Awadie H, Ramchandani M, Nabi Z et al. eP132 PRACTICE VARIATION EXISTS IN THE PERFORMANCE OF PER ORAL ENDOSCOPIC MYOTOMY (POEM): RESULTS OF AN INTERNATIONAL SURVEY OF POEM EXPERTS. Endoscopy 2021; 53: S140.

Publication History

Article published online:
19 March 2021