1: A POEM equipment checklist should be used before commencing the procedure to ensure the availability and proper functioning of all necessary materials. 2: A thorough esophageal cleansing before mucosal incision is mandatory. There should be no residual dietary liquid or food in the lumen. 3: Use at least 5-10 mL of lifting agent, which should be injected using a needle at the desired point where the mucosotomy will commence. 4: To 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 45-80° to the mucosal surface. 5: After adequate submucosal injection (through a needle or knife), the incision should be extended by 1.5-2 cm in the longitudinal axis from cranial to caudal, in the planned direction of the tunnel. 6: Dissection 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-muscularis propria interface is important to facilitate mucosal tunneling. 7: The myotomy should be performed in a cranial to caudal manner, starting 2 cm or more below the caudal extent of the mucosotomy site. 8: ESGE recommends that the myotomy should be extended 2-3 cm distal to the gastroesophageal junction to allow complete disruption of the lower esophageal sphincter. 9: ESGE recommends that POEM can be performed on either the anterior (1-2 o'clock in supine position) or posterior (5-6 o'clock) side. 10: ESGE 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. 11: ESGE 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. 12: Mucosal 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. 13: ESGE recommends performing POEM using low flow CO2 insufflation. 14: In the absence of adverse events, resume fluids on day 1, soft diet on day 3, and normal diet on day 7 post-POEM. 15: ESGE recommends against the routine use of standard or computed tomography fluoroscopic esophagrams after POEM in asymptomatic patients.

Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas Madrid Spain

Charlotte Maxeke Johannesburg Academic Hospital Johannesburg South Africa

Clarunis Universitäres Bauchzentrum Basel Switzerland

Clinical Medicine University of California San Francisco California USA

Department of Gastroenterology and Hepatology Amsterdam UMC Amsterdam The Netherlands

Department of Gastroenterology and Hepatology Hospital Universitario Ramón y Cajal Madrid Spain

Department of Gastroenterology and Hepatology St Anne University Hospital Brno Czech Republic

Department of Gastroenterology and Hepatology University Hospital of Ghent Ghent Belgium

Department of Gastroenterology University Hospital Augsburg Augsburg Germany

Department of Gastrointestinal Endoscopy The Military University Hospital Prague Prague Czech Republic

Digestive Endoscopy Unit Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Division of Gastroenterology Ulster Hospital Belfast Northern Ireland

Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology Emek Medical Center Afula Israel

Endoscopy and Motility Unit Gastroenterology Department Hospital Clinic de Barcelona Barcelona Spain

Faculty of Medicine and Health Sciences University of Ghent Ghent Belgium

Gastroenterology Department Centro Hospitalar S João Porto Portugal

Gastroenterology Department Hospital Universitario de Navarra Navarrabiomed UPNA IdiSNA Pamplona Spain

Gastrointestinal Endoscopy Unit Hospital das Clínicas of the University of São Paulo Medical School São Paulo Brazil

Instituto Ramón y Cajal de Investigación Sanitaria Madrid Spain

Pancreatobiliary Endoscopy Services Division of Digestive and Liver Disease Columbia University Irving Medical Center New York New York USA

Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa Israel

Università Politecnica delle Marche Ancona Italy

University Clinic Zaporizhzhia State Medical and Pharmaceutical University Zaporizhzhia Ukraine

University Hospital of Brussels Brussels Belgium

University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca Romania

University of the Witwatersrand Johannesburg South Africa

Waikato Hospital Hamilton New Zealand

Wits Donald Gordon Medical Centre Johannesburg South Africa

Citace poskytuje Crossref.org