The Blown-Out Myotomy and Post-POEM Dysphagia

Per-oral endoscopic myotomy (POEM) has emerged as an effective, minimally invasive treatment option for achalasia, though post-procedural dysphagia remains a concern. Common causes include gastroesophageal reflux, inadequate myotomy, and blown-out myotomy (BOM). BOM is characterized by pseudodiverticulum formation at a prior myotomy site. Longer myotomy length is commonly associated as a risk factor for BOM formation. Management is challenging, and endosurgical interventions are emerging, including per-oral plicaiton of the esophagus (POPE). Minimizing myotomy length during POEM may help reduce BOM rates. In this review, we discuss an approach to post-POEM dysphagia, with highlights on BOM from diagnosis to management.