POEM (Endoscopic Peroral Myotomy) for Achalasia
The esophageal sphincter muscles are critically important for swallowing. When these muscles cease to function correctly, patients are often diagnosed with motility disorders – abnormal power and nerve movements along the GI system. The most common swallowing problem is achalasia, where the esophageal sphincter muscles do not relax. The result is that patients have difficulty swallowing, and food may not pass into the stomach properly – essentially, patients have difficulty eating. Beyond the discomfort associated with drinking, patients may experience compromised quality of life because of significant heartburn and unintentional weight loss.
Until recently, the gold standard surgical treatment for achalasia and some other esophageal dysmotility was a procedure known as a Heller Myotomy, which involves minimally invasive surgery to cut the musculature of the esophageal sphincter and relax it. While this is often suitable for type I and type II achalasia, its outcomes for type III achalasia, which occurs in about 10% of achalasia patients, are less predictable.
Today, we perform a very successful procedure known as POEM or Peroral Endoscopic Myotomy using a non-surgical technique known as endoscopy. Endoscopy allows us to complete the procedure from the inside without external incisions. The endoscope is a flexible tube that passes through the mouth and into the esophagus. There’s no need for an incision in the chest or abdomen. Not only does this reduce potential complications, but it also minimizes blood loss, pain, and recovery. Further, the endoscopic technique allows for a longer myotomy, which benefits those with type III achalasia or other less common esophageal motility disorders.
SAMPA is proud to be one of a handful of practices in the United States performing the POEM procedure.
How POEM Is Performed
The POEM procedure is performed under general anesthesia. The endoscope is passed through the esophagus and, using a specially made cutting device connected to the end of the endoscope; we cut specific areas of the esophageal muscles and the upper part of the stomach to widen the pathway for food and drink to enter the stomach. Endoscopic clips are placed to maintain results.
POEM typically requires one night at the hospital. The day after the procedure, you will undergo a barium swallow to verify that the muscle remains open and that there is no visible leakage. You will then have at least two more follow-up visits, one of which will further test for maintenance of the esophageal opening.
Risks of the Surgery
As with any surgical procedure, there are risks inherent to general anesthesia and endoscopy. However, if you have been referred for endoscopic intervention or surgery for achalasia or any form of esophageal dysmotility that would benefit from POEM, we believe that the procedure’s benefits outweigh any potential risks. Indeed, the procedure offers patients an excellent option to dramatically improve their quality of life, if they qualify.
For more information, we encourage you to contact our office and schedule a consultation with one of our digestive disorder specialists. We will discuss the various options available to you for treating achalasia and other esophageal dysmotility and schedule you for surgery or endoscopic intervention if you qualify.