POEM, GPOEM, and ZPOEM

Our tripartite narrative review discusses Peroral Endoscopic Myotomy (POEM), gastric POEM (GPOEM) and POEM for Zenker's diverticula (ZPOEM). POEM is the prototypical procedure that launched the novel 3rd space endoscopy field of advanced endoscopy. It revolutionized achalasia therapy by offering a much less invasive version of the prior gold standard, the laparoscopic Heller myotomy (HM). We review in detail indications, outcomes, technique variations and comparative data between POEM and HM particularly with regard to the hotly debated issue of GERD. We then proceed to discuss two less illustrious but nevertheless important offshoots of the iconic POEM procedure: GPOEM for gastroparesis and ZPOEM for the treatment of hypopharyngeal diverticula. For GPOEM, we discuss the rationale of pylorus-directed therapies, briefly touch on GPOEM technique variations and then focus on the importance of proper patient selection and emerging data in this area. On the third and final part of our review, we discuss ZPOEM and expound on technique variations including our ultra-short tunnel technique. Our review emphasizes that, despite the superiority of endoscopy over surgery for the treatment of hypopharyngeal diverticula, there is no clear evidence yet of the superiority of the newfangled ZPOEM technique compared to the conventional endoscopic myotomy technique practiced for over two decades prior to the advent of ZPOEM.

Automated summary

Our narrative review discusses three procedures: Peroral Endoscopic Myotomy (POEM), gastric POEM (GPOEM), and POEM for Zenker's diverticula (ZPOEM). POEM revolutionized achalasia therapy by offering a less invasive alternative to the laparoscopic Heller myotomy (HM). We delve into indications, outcomes, technique variations, and comparative data between POEM and HM. Additionally, we discuss GPOEM for gastroparesis and ZPOEM for hypopharyngeal diverticula. Our review emphasizes the lack of clear evidence supporting the superiority of ZPOEM over traditional endoscopic myotomy techniques.