Peroral Endoscopic Myotomy (POEM)

Peroral endoscopic myotomy (POEM) is medically necessary for symptomatic, manometrically confirmed primary (idiopathic) achalasia of Chicago Classification types I–III and may be performed even after prior therapies such as pneumatic dilation, botulinum toxin injection, or laparoscopic Heller myotomy. Required preoperative documentation includes a history and physical with Eckardt score ≥3, high-resolution esophageal manometry with Chicago Classification, contrast esophagram, and EGD; patients must be counseled about GERD risk and follow-up acid suppression. POEM is contraindicated in severe erosive esophagitis, significant coagulopathy, liver cirrhosis with portal hypertension, severe pulmonary disease, esophageal malignancy, and recent esophageal procedures or therapies causing submucosal fibrosis, and must be performed by adequately trained physicians at high-volume centers able to manage immediate complications.

"POEM is medically necessary for symptomatic, manometrically proven primary (idiopathic) achalasia classified as Chicago Classification types I, II, or III."