STEPS to POEM: introduction of a new technique at the IRCAD.

The future of natural orifice transluminal endoscopic surgery lies not just in the reduction of the invasiness of selected surgical procedures, but more in the development of innovative surgical concepts and revisitation of old surgical dogmas. This is particularly true for minimally invasive oesophageal surgery which is still relatively new and therefore an ideal field for improvement as it presents many unanswered questions. Endoluminal and transluminal esophageal endoscopic procedures for both diagnostic and therapeutic purposes have recently been explored. Most impressively perhaps Haruhiro Inoue{H. Inoue, 2010 #191}, has recently reported the first clinical experience of submucosal endoscopic esophageal myotomy for esophageal achalasia with a peroral endoscopic myotomy (POEM). In addition to being a no-scar technique the true innovation and appeal of the POEM procedure is that it specifically targets the circular muscle layers of the LES affected by achalasia, thereby preserving the anatomic integrity of the LES anatomy and possibly minimizing surgical side effects such as gastroesophageal reflux. However, the low incidence of in combination with POEM technical demands makes the design of a pathway to introduce this into clinical practice a challenge. We describe our recommendations for starting a POEM program based on our own experience and describe the first clinical case of POEM performed at the University of Strasbourg, as well as being the first in France, to illusa model for other institutions wishing to introduce POEM into their clinical repertory.