Myotomy

Myotomy is a surgical procedure aimed at the precise and controlled cutting of muscle fibers that are overactive or do not relax properly.
In the context of Achalasia, the myotomy focuses on the lower esophageal muscles and the lower esophageal sphincter (LES), which fail to open properly and prevent the free passage of food and liquids into the stomach.

During the procedure, only the muscle layer is deliberately cut, while preserving the mucosal layer, with the goal of:

• Reducing the pressure in the lower esophageal sphincter
• Improving the passage of food and liquids
• Relieving symptoms such as difficulty swallowing, sensation of blockage, and chest pain

In the POEM procedure, the myotomy is performed using an advanced endoscopic approach, through the esophageal lumen, without external incisions. This technique allows for a precise cut along a personalized length of the problematic muscle, according to the type of achalasia and patient characteristics.

The advantages of endoscopic myotomy include:

• High precision and minimal damage to adjacent tissues
• Better control over the depth and length of the cut
• Reduced risk of complications compared to open surgical approaches
• Faster recovery and improvement in quality of life

Successful myotomy requires a high level of technical skill, deep anatomical understanding, and extensive clinical experience, especially when performed as part of the POEM procedure using the Third Space Endoscopy technique.