Further efforts are needed to identify a new, easy-to-use endoscopic technology

with a simple classification system that could improve the detection of HGD and EAC in patients with BE. “
“Spastic esophageal motility disorders often present with dysphagia, regurgitation, and chest pain.1 These motility disorders are treated medically with smooth muscle relaxants or pneumatic balloon dilatation. Surgically they are treated with myotomy of the esophageal body and/or the gastroesophageal junction.2 Esophageal achalasia is the best described of these disorders, and it can be treated either by serial balloon dilations or a laparoscopic Heller myotomy.3 and 4 Both procedures disrupt

all or some of the muscle layers of the lower esophageal sphincter (LES). The laparoscopic Heller myotomy is an efficient, Dabrafenib ic50 one-time intervention, having documented proof of consistent and long-lasting palliation of dysphagia in more than 90% of achalasia patients.5 and 6 In our experience, surgical find more myotomy has similar good results in other primary disorders of the LES as well (namely, hypertensive non-relaxing LES). Regardless of how the sphincter is divided, patients typically have a substantial and persistent improvement in dysphagia scores after these interventions.7 Methocarbamol Peroral endoscopic myotomy (POEM) has been described as a less invasive alternative to an esophageal myotomy without the need for a thoracoscopic or laparoscopic approach.8 Mastery of the peroral endoscopic myotomy technique is evidenced by a decrease in length of procedure, variability of minutes per centimeter of myotomy, and incidence of inadvertent mucosotomies. Currently, over 1000 clinical cases of POEM have been performed worldwide. There is growing enthusiasm for the procedure on the part of foregut surgeons and interventional endoscopists (and surgical endoscopists). However, POEM is essentially

a flexible natural orifice transluminal endoscopic surgery (NOTES) procedure and therefore represents a new paradigm for both laparoscopic surgeons and interventional endoscopists. Even surgeons who are considered experts in laparoscopic myotomy can be expected to have a significant learning curve if they are not skilled at flexible endoscopy. Likewise, even the most skilled interventional endoscopist may be disoriented with the intramural anatomy of the LES or by suddenly being in the mediastinum or dealing with tension pneumothoraces, mediastinal hemorrhages, or other complications that have been reported for POEM. Laboratory or simulator training before starting this novel procedure on humans would seem to be mandatory.