Economic Impact of POEM and ESD: GIE | June 2026

Introduction:

Peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) have revolutionized the management of esophageal motility disorders and early gastrointestinal neoplasia. Despite their proven clinical benefits, widespread adoption has been limited by concerns regarding procedure costs and relatively low reimbursement.

Why was this study needed?

Hospital administrators often view POEM and ESD as financially unattractive because of their complexity and low procedural reimbursement. This study evaluated whether these advanced endoscopic procedures generate broader economic value through downstream healthcare utilization.

What did the study show?

• The study analyzed 825 patients undergoing POEM or ESD at a high-volume tertiary center between 2018 and 2024.
• Although direct procedural reimbursement was relatively low (15.5%–22.4%), the program generated $73.5 million in total physician and hospital charges.
• Downstream care accounted for $39.9 million in additional healthcare charges.
• Overall reimbursement reached $15.7 million during the study period.
• The program attracted 349 new referral patients, generating an additional $28.5 million in healthcare charges and $5.8 million in reimbursements.
• The financial benefits extended well beyond the endoscopic procedures themselves through referrals, follow-up care, imaging, surgery, and multidisciplinary services.

Clinical Impact:

The value of POEM and ESD should be assessed across the entire healthcare system rather than by procedural reimbursement alone. Investment in third-space endoscopy programs can strengthen referral networks, improve patient access to advanced therapies, and generate substantial long-term institutional revenue.

Take-Home Message:

POEM and ESD are not only clinically transformative but also economically valuable. While direct procedural reimbursement remains modest, the substantial downstream revenue and referral growth make advanced endoscopy programs a worthwhile investment for healthcare systems.