{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T02:43:35Z","timestamp":1786761815459,"version":"build-2736575974"},"reference-count":134,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Main Recommendation<\/jats:title><jats:p>\n               1\u2002A POEM equipment checklist should be used before commencing the procedure to ensure the availability and proper functioning of all necessary materials.<\/jats:p><jats:p>\n               2\u2002A thorough esophageal cleansing before mucosal incision is mandatory. There should be no residual dietary liquid or food in the lumen.<\/jats:p><jats:p>\n               3\u2002Use at least 5\u201310\u200amL of lifting agent, which should be injected using a needle at the desired point where the mucosotomy will commence.<\/jats:p><jats:p>\n               4\u2002To create the mucosotomy, the first incision should be made at the site of previous injection with the fewest possible taps on the electrosurgical unit using a cutting mode, with the knife tip at 45\u201380\u00b0 to the mucosal surface.<\/jats:p><jats:p>\n               5\u2002After adequate submucosal injection (through a needle or knife), the incision should be extended by 1.5\u20132\u200acm in the longitudinal axis from cranial to caudal, in the planned direction of the tunnel.<\/jats:p><jats:p>\n               6\u2002Dissection within the tunnel should be performed using sequential injection of saline and chromic dye (if available using the knife jet function) and dissection with the knife. Pushing the endoscope forward gently against the advancing submucosa\u2013muscularis propria interface is important to facilitate mucosal tunneling.<\/jats:p><jats:p>\n               7\u2002The myotomy should be performed in a cranial to caudal manner, starting 2\u200acm or more below the caudal extent of the mucosotomy site.<\/jats:p><jats:p>\n               8\u2002ESGE recommends that the myotomy should be extended 2\u20133\u200acm distal to the gastroesophageal junction to allow complete disruption of the lower esophageal sphincter.<\/jats:p><jats:p>\n               9\u2002ESGE recommends that POEM can be performed on either the anterior (1\u20132\u00a0o\u2019clock in supine position) or posterior (5\u20136\u00a0o\u2019clock) side.<\/jats:p><jats:p>\n               10\u2002ESGE recommends that the myotomy length should be tailored to the disease being treated, with evidence favoring short esophageal-side myotomy if indicated because of decreased adverse events and procedure times.<\/jats:p><jats:p>\n               11\u2002ESGE recommends the use of through-the-scope clips for mucosal closure owing to their high efficacy and availability, and lower price compared with other closure methods.<\/jats:p><jats:p>\n               12\u2002Mucosal injury during POEM should be proactively sought during the procedure and particularly before completion. Mucosal injury can be represented on a spectrum from whitening of the overlying mucosa to a full-thickness perforation.<\/jats:p><jats:p>\n               13\u2002ESGE recommends performing POEM using low flow CO2 insufflation.<\/jats:p><jats:p>\n               14\u2002In the absence of adverse events, resume fluids on day 1, soft diet on day 3, and normal diet on day 7 post-POEM.<\/jats:p><jats:p>\n               15\u2002ESGE recommends against the routine use of standard or computed tomography fluoroscopic esophagrams after POEM in asymptomatic patients.<\/jats:p>","DOI":"10.1055\/a-2569-7634","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T20:02:17Z","timestamp":1748462537000},"page":"912-941","source":"Crossref","is-referenced-by-count":12,"title":["Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) \u2013 Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-0434","authenticated-orcid":false,"given":"David J.","family":"Tate","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium"},{"name":"Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2852-6042","authenticated-orcid":false,"given":"Enrique","family":"Rodriguez de Santiago","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Hospital Universitario Ram\u00f3n y Cajal, Madrid, Spain"},{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS), Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red en el \u00c1rea tem\u00e1tica de Enfermedades Hep\u00e1ticas y Digestivas (CIBEREHD), Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian M.","family":"Gralnek","sequence":"first","affiliation":[{"name":"Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel"},{"name":"Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3304-0271","authenticated-orcid":false,"given":"Tony C.","family":"Tham","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Montori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium"},{"name":"Universit\u00e0 Politecnica delle Marche, Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Lala","sequence":"additional","affiliation":[{"name":"University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa"},{"name":"Wits Donald Gordon Medical Centre, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0566-7456","authenticated-orcid":false,"given":"Lynn K.","family":"Debels","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium"},{"name":"University Hospital of Brussels, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9311-3746","authenticated-orcid":false,"given":"Eduardo","family":"Alb\u00e9niz","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Hospital Universitario de Navarra. 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