POEM is a form of natural orifice translumenal endoscopic surgery, or NOTES. Like the traditional surgical<unk> , the procedure is<unk> formed under general endotracheal anesthesia. The remainder of the procedure is<unk> formed using a flexible endoscope inserted through the mouth, and no cuts are made on the chest or abdomen. Occasionally, an “overtube” is inserted to facilitate repeated removal & insertion of the endoscope. First, a submucosal injection of dyed saline creates a cushion, then a cut is made in the esophageal mucosa using electrocautery roughly 13 centimeters proximal to the lower esophageal sphincter. Then, using hydrostatic dissection and electrocautery, the submucosal tunnel is made. Once the circular fibers of the lower esophageal sphincter are encountered, they are divided using electrocautery all the way down onto the first part of the stomach. This functionally weakens the sphincter, allowing improved passage of food and liquid into the stomach. Finally, the submucosal flap is closed using clips or sutures also placed through the endoscope. The procedure takes roughly 2 hours but can vary on physician and patient characteristics. Patients usually spend 1–3 days in the hospital before going home, and usually undergo a swallow study prior to resuming<unk>  feeding. Patients may return to work and full activity immediately upon discharge from the hospital. Long-term patient satisfaction is similar following POEM compared to standard laparoscopic Heller<unk> .
Per-oral endoscopic myotomy
Endoscopic foreign body retrieval
Heller myotomy
Transoral incisionless fundoplication
Adjustable gastric band
Esophageal stent
Endoscopic ultrasound
Endoscopic submucosal dissection