RT Book, Section A1 Hunter, John G. A1 Spight, Donn H. A1 Sandone, Corinne A1 Fairman, Jennifer E. SR Print(0) ID 1162529979 T1 Peroral Endoscopic Myotomy (Poem) T2 Atlas of Minimally Invasive Surgical Operations YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9780071449052 LK accesssurgery.mhmedical.com/content.aspx?aid=1162529979 RD 2024/03/29 AB Patients found to have achalasia are candidates for peroral endoscopic myotomy (POEM). Workup should include endoscopy, upper GI series, and high-resolution esophageal manometry to confirm the diagnosis of achalasia and rule out paraesophageal hernia or other pathology that might confound the creation of a submucosal tunnel. Although the presence of a hiatal hernia is not a strict contraindication to POEM, the patient should be counseled about the likelihood of reflux that will occur, because an antireflux procedure is not associated with this approach as with a traditional laparoscopic Heller myotomy. Patients should also be consented for laparoscopic surgery so that the threshold to convert to a laparoscopic or hybrid approach is low in the event of safety concerns.