Evolving Indications of Esophageal Peroral Endoscopic Myotomy (E-POEM): A Review of Expanding Applications in Esophageal Pathologies

Abstract

Purpose of review: Since its introduction in 2010, peroral endoscopic myotomy (POEM) has reshaped the management of esophageal motility disorders. Originally designed for achalasia, it has expanded into a versatile therapeutic option for a range of esophageal conditions. This review summarizes current evidence on the role of esophageal POEM (E-POEM) across diverse pathologies. Recent findings: Emerging data suggest favorable outcomes of E-POEM for non-achalasia disorders, including spastic esophageal disorders, esophagogastric junction outflow obstruction (EGJOO), diverticular disease, revisional therapy, and other rare indications. However, the evidence remains limited, and careful patient selection is essential before offering treatment. E-POEM has progressed from a procedure for classical achalasia to a promising approach for complex and refractory esophageal conditions. Its broader application may be beneficial when performed in appropriately selected patients under expert hands.