Peroral Endoscopic Myotomy

Peroral Endoscopic Myotomy (POEM)

Peroral endoscopic myotomy (POEM) is an endoscopic treatment for achalasia. It uses endoscopy rather than conventional surgery, which involves incisions in the abdomen and/or chest. Achalasia is a relatively rare condition which affects swallowing. Initial symptoms include the sensation of food or liquid “getting stuck on the way down.” These symptoms may progress and patients may experience chest pains, regurgitation, and weight loss or nutritional problems.  In patients with achalasia, the lower esophageal sphincter is too tight and will not relax. POEM allows for complete division of the spastic muscle fibers allowing for improved swallowing.

How Is POEM Performed?

While the patient is under general anesthesia, the endoscopist passes the flexible endoscope through the mouth into the esophagus. A small incision is made in the innermost layer of the esophagus (the mucosa) using specialized electrosurgical instruments. The endoscope is then tunneled down the remaining length of the esophagus in the layer called the submucosa. In the lower esophagus, the endoscopist cuts the muscle fibers of the lower esophageal sphincter which releases the excessive pressure. The endoscope is removed and the first incision made in the mucosa is closed with small clips or sutures. Patients who experience difficulties with swallowing and sometimes with unexplained chest pain should consider diagnostic testing. Testing could include radiology studies, endoscopy and esophageal manometry. Some, but not all patients may have achalasia.

Who Needs POEM?

Patients with difficulty swallowing due to achalasia may be treated with POEM.

What Are The Potential Complications of POEM?

POEM is generally a safe procedure. Rare complications include bleeding and a puncture (or perforation) in the lining of the esophagus. If you notice blood in your stool, black stool, fever, chills, vomiting, chest pain, stomach pain or shortness of breath, contact your doctor as instructed on your discharge papers. Some patients may experience reflux symptoms after POEM. In most instances, this can be treated with dietary and lifestyle modification and/or medication.

What Do I Need To Do Before POEM?

Your doctor will ask you to limit your diet to full liquids 2 days before the procedure, and then clear liquids 1 day (24 hours) before the procedure. You should take nothing by mouth for 12 hours. You will be given intravenous fluids and antibiotics prior to the procedure. Your doctor may alter your medicines, particularly if you take blood thinning medication or have diabetes.

What Happens After POEM?

After the POEM procedure, you will be observed in the hospital overnight. You will be evaluated the following day prior to discharge. You will be asked to consume a liquid diet for about 1 week, then soft food, advancing to a regular diet as tolerated. You will be given an acid-reducing medicine to take which helps with the healing process. The results of the procedure will be communicated to your other physician(s). You will be scheduled for follow up at the office.