CPT® Code 43497

Transoral lower esophageal myotomy, also known as peroral endoscopic myotomy (POEM), is a specialized therapeutic endoscopic procedure designed to address issues related to the lower esophagus. This procedure involves the precise cutting and removal of muscle tissue from the lower esophagus, utilizing an endoscope that is inserted through the mouth. The POEM technique is recognized as a less invasive alternative to the traditional laparoscopic Heller myotomy, which is often performed for similar indications. The primary aim of the POEM procedure is to treat achalasia, a rare motility disorder characterized by the esophagus's inability to effectively transport food and liquids into the stomach. In addition to achalasia, POEM may also be employed to manage various esophageal motility disorders, including spastic esophagus, diffuse esophageal spasm, jackhammer esophagus, and type 3 achalasia. During the procedure, an endoscope equipped with a camera and a specialized knife is carefully navigated through the mouth and into the esophagus, targeting the area of muscle tightness. A longitudinal incision is made in either the anterior or posterior section of the esophageal mucosa, allowing access to the submucosal layer while preserving the integrity of the mucosa. The endoscope is then advanced within the submucosa, extending slightly beyond the gastroesophageal junction (GEJ). The myotomy itself can be performed using either a full-thickness or selective muscle technique, with the latter focusing on the removal of the inner circular muscle layer at the GEJ while sparing the outer muscle layer. To ensure patient safety, any active bleeding that may occur during the procedure is promptly controlled before the incision is closed. Furthermore, POEM procedures can be combined with other separately reportable anti-reflux interventions, such as transoral incisional fundoplication, to mitigate the risk of post-surgical gastroesophageal reflux disease, a potential complication following the procedure.