Evidence map›Paper›PMID 40399617›Full record

GuidelineSurgical endoscopy2025

2024 Update to SAGES guidelines for the use of peroral endoscopic myotomy (POEM) in the treatment of achalasia.

Elisa C Calabrese, Tammy Kindel, Bethany J Slater, Jeffrey Marks, Lee Swanstrom, Payal Saxena, Salvatore Docimo, Dimitrios I Athanasiadis, Nader M Hanna, Dimitrios Stefanidis and 3 more

Abstract readPractice Guideline
PubMed Publisher
In one paragraph

Guideline in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. The per-oral endoscopic myotomy (POEM) era in Saudi Arabia: Bridging tertiary-center experience with clinical care pathways.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026
    Article
  8. Saudi Gastroenterology Association (SGA) clinical care pathway and standards of care for peroral endoscopic myotomy (POEM) in achalasia.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026
    Article
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Elisa C CalabreseDepartment of Surgery, University of California-East Bay, 1411 E 31St St, Oakland, CA, 94602, USA. eclbrs@gmail.com.ORCID http://orcid.org/0009-0007-0217-7933
Tammy KindelDepartment of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Bethany J SlaterDepartment of Surgery, University of Chicago, Chicago, IL, USA.
Jeffrey MarksDepartment of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Lee SwanstromOregon Health and Sciences University, Portland, OR, USA.
Payal SaxenaDepartment of Gastroenterology, Royal Prince Alfred Hospital, Chris O'Brien Lifehouse, University of Sydney, Sydney, Australia.
Salvatore DocimoDepartment of Surgery, University of South Florida, Tampa, FL, USA.
Dimitrios I AthanasiadisDepartment of General Surgery, Indiana University, Indianapolis, IN, USA.
Nader M HannaDepartment of Surgery, McMaster University, Hamilton, Canada.
Dimitrios StefanidisDepartment of Surgery, Indiana University, Indianapolis, IN, USA.
Ceciel RookerInternational Foundation for Gastrointestinal Disorders, Milwaukee, WI, USA.
Guy MaddernDepartment of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
Geoffrey P KohnEastern Clinical Research Unit, Monash University, Melbourne, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPeroral Endoscopic Myotomy (POEM) is a safe treatment for esophageal achalasia with comparable safety to Heller myotomy plus fundoplication and pneumatic dilatation (PD). More data comparing POEM to Heller Myotomy plus fundoplication and pneumatic dilation are available since the previous Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline published on this topic in 2021.

objectiveThis guideline provides an update to the evidence-based guideline from SAGES published in 2021. It is intended to support clinicians, surgeons, and patients in decisions about the use of POEM for the treatment of achalasia.

resultsThe panel agreed on 3 recommendations for adults with achalasia. A conditional recommendation for the use of POEM over PD was issued. Conditional recommendations included the option of using either POEM with appropriate use of proton pump inhibitors (PPIs) or HM with fundoplication to treat achalasia. POEM was favored over HM with fundoplication for achalasia subtype III. No new literature was found for children, and the previous recommendation from 2021 should be referred to for this population.

conclusionsPOEM is a safe and effective treatment for achalasia in adults. It demonstrates greater efficacy than PD, though there are specific situations where PD may be the more appropriate choice. POEM has previously been compared to Heller myotomy, but this comparison is less relevant to modern surgical practice. Shifting the paradigm, POEM plus appropriate use of PPIs should be compared to Heller plus fundoplication. This reflection of current practice allows for a conditional recommendation for either approach in the treatment of achalasia subtypes 1 and 2, and for a preference of POEM for subtype 3.

Indexed as

Esophageal AchalasiaEsophagoscopyMyotomyNatural Orifice Endoscopic SurgeryAdultEsophageal Sphincter, LowerFundoplicationHeller MyotomyHumansAchalasiaEndoscopyGuidelineHeller myotomyPer-oral endoscopic myotomy (POEM)RecommendationsSurgery

Identifiers

PMID40399617

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.