POEM (Peroral Endoscopic Myotomy)
POEM (Peroral Endoscopic Myotomy) is a minimally invasive procedure for the treatment of esophageal motility disorders (EMDs). EMDS are a group of conditions where the muscles of the esophagus fail to contract effectively to deliver food and liquid to the stomach. The most common EMD is achalasia. When you eat, the muscle in your lower esophagus should relax to let food pass into the stomach. Patients with achalasia have a ring of muscle called the lower esophageal sphincter that becomes too tight, making it hard for liquids and solid foods to pass through normally. This condition can happen at any age and the cause of this disease is not known. Symptoms of achalasia include regurgitation, heartburn, chest pain, feeling that something is stuck in the throat or chest, and even weight loss and nutrient deficiencies. POEM can also treat other disorders that cause spasms in the esophagus and that do not respond to drug treatment, such as diffuse esophageal spasm and nutcracker or jackhammer esophagus.
How is POEM performed?
POEM is performed in an operating room while you are asleep under general anesthesia. Dr. Chris Reising inserts a small flexible endoscope into your mouth and down the esophagus. An incision is made in the lining of esophagus and a tunnel is created between the inside lining of the esophagus and the muscles around the outside of the esophagus. Once the tunnel is created, Dr. Reising will cut the esophageal muscles (called myotomy) that are too tight and constricting the lower esophagus. This widens the space for liquids and foods to pass freely into the stomach. The procedure takes about an hour to complete.
What are the benefits of POEM?
- Faster recovery time, returning to an active lifestyle sooner
- POEM is not a surgery, so there are no cuts are scars on the outside of the body
- Safer for patients that have heart, lung, or kidney problems, patient who are morbidly obese, and patients who have had previous upper abdominal surgeries
What happens after the procedure?
Dr. Reising will admit you for an overnight stay in the hospital to monitor you closely. He will order an X-ray on your esophagus (esophagram) to make sure the surgical area is adequately sealed before you are given anything to drink. You will then start a full liquid diet. You will be given IV hydration and antibiotics before and after the procedure until you are ready to go home the next day. Pain medication is sometimes needed but most patients have no pain the next day. Your diet will progress to a soft diet after the first 2 weeks and will be advanced at your follow up visit.
