The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia.

The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20−40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure.

这篇综述的目的是描述在目前可用于robust门失弛缓的有效治疗方法中的经口内镜下肌切开术（POEM）的位置。

本评论中概述的建议基于专家意见以及PubMed和EMbase的相关出版物。美国胃肠病学协会临床实践更新委员会提出以下建议：1）在确定对门失弛缓症治疗的需要时，应考虑患者的具体参数（芝加哥分类亚型，合并症，早期与晚期疾病，原发或继发原因）具有公开的功效数据；2）考虑到该程序的复杂性，POEM应该由经验丰富的医师在大容量医疗中心进行，因为要获得能力，估计需要20-40程序；3）如果具备专业知识，则应考虑将POEM视为III型ach门失弛缓症的主要疗法；4）如果有专业知识，对于任何门失弛缓综合症，应将POEM视为可与腹腔镜Heller肌切开术相媲美的治疗选择；5）POEM后的患者在进行手术前应被视为发生反流性食管炎的高风险患者，并应告知其管理考虑因素（潜在的不确定性质子泵抑制剂治疗和/或监测内窥镜检查）。