POEM

Peroral Endoscopic Myotomy (POEM) is an advanced, minimally invasive endoscopic procedure used primarily for the treatment of achalasia, a condition in which the muscles of the lower end of the food pipe (esophagus) do not relax properly, making it difficult for food and liquids to pass into the stomach.

POEM provides an effective treatment option without the need for external surgical cuts. The procedure is performed through the mouth using a flexible endoscope and specialized instruments. By creating a small tunnel within the wall of the esophagus and carefully cutting the abnormal muscle fibers, POEM helps relax the tight lower esophageal sphincter and improves the passage of food into the stomach.

For patients struggling with persistent difficulty swallowing, regurgitation, chest discomfort, or other symptoms related to achalasia, POEM can offer significant symptom relief and help improve their ability to eat and drink more comfortably.

What is Achalasia?

Achalasia is a relatively uncommon disorder of the esophagus. Normally, when a person swallows food, coordinated muscle movements push the food down the esophagus. At the same time, the lower esophageal sphincter relaxes to allow food to enter the stomach.

In achalasia, this relaxation does not occur normally. As a result, food and liquids can become trapped in the esophagus instead of passing easily into the stomach.

Common symptoms may include:

• Difficulty swallowing food or liquids 
• Feeling that food is getting stuck in the chest 
• Regurgitation of undigested food or liquids 
• Chest discomfort or pain 
• Heartburn-like symptoms 
• Unintentional weight loss 
• Coughing, particularly at night 
• Difficulty eating certain types of food 

If left untreated, achalasia can progressively affect eating, nutrition, sleep, and overall quality of life.

How Does POEM Work?

POEM is performed using a flexible endoscope that is passed through the mouth into the esophagus. There are no external incisions or surgical cuts on the abdomen or chest.

During the procedure, the doctor makes a small entry point in the inner lining of the esophagus. A specialized endoscopic technique is then used to create a tunnel within the esophageal wall. This tunnel allows the doctor to reach the muscle layer responsible for the abnormal tightening.

The muscle fibers are carefully divided in a controlled manner. This is known as myotomy. By cutting the selected muscle fibers, particularly around the lower esophageal sphincter, the resistance to the passage of food is reduced.

Once the myotomy is completed, the endoscopic entry point is closed using specialized endoscopic clips. The entire procedure is performed internally, meaning there is no conventional external surgical incision.

Who May Benefit From POEM?

POEM is most commonly used for patients with achalasia, particularly those who have significant swallowing difficulties or other symptoms affecting their daily life.

It may also be considered in selected patients with certain other disorders involving abnormal contraction or increased pressure of the esophageal muscles.

The suitability of POEM depends on several factors, including the type and severity of the condition, symptoms, findings from investigations, previous treatments, and the patient’s overall health.

Before recommending POEM, the doctor may perform investigations such as:

• Upper gastrointestinal endoscopy 
• Esophageal manometry 
• Barium swallow or timed barium esophagram 
• Other investigations when required 

These tests help confirm the diagnosis and understand how the esophagus is functioning.

Benefits of POEM

One of the major advantages of POEM is that it provides a minimally invasive way to treat the underlying muscle problem in achalasia.

Potential benefits include:

• No external surgical incision 
• Minimally invasive endoscopic approach 
• Direct treatment of the abnormal esophageal muscle 
• Improvement in swallowing difficulties 
• Reduction in food and liquid regurgitation 
• Potential improvement in chest discomfort associated with achalasia 
• Faster recovery compared with some conventional surgical approaches 
• Ability to treat different types of achalasia in appropriately selected patients 

POEM can be particularly useful when the abnormal muscle segment extends higher up the esophagus, as the length of the myotomy can be tailored according to the patient’s condition.

POEM vs Traditional Surgery

A traditional surgical treatment for achalasia is Heller myotomy, which involves making surgical incisions to access and divide the lower esophageal muscle.

POEM, in comparison, uses an endoscopic approach through the mouth. The muscle is accessed through a submucosal tunnel rather than through external surgical incisions.

Both treatments can be effective, but the appropriate option depends on the patient’s specific condition and clinical findings. POEM is not automatically the best choice for every patient.

An experienced specialist can evaluate the patient’s symptoms, investigations, achalasia subtype, and previous treatments before recommending the most appropriate approach.

What to Expect After POEM?

After the procedure, patients are monitored carefully during recovery. The doctor may initially recommend restrictions on oral intake and then gradually introduce liquids and soft foods depending on the individual situation.

Most patients can gradually return to their usual activities as advised by their treating team. Recovery time varies depending on the patient’s overall health and the complexity of the procedure.

Follow-up is important after POEM. The doctor will assess swallowing, regurgitation, dietary tolerance, and overall improvement in symptoms.

One possible long-term issue after POEM is acid reflux, because relaxing the lower esophageal sphincter can make it easier for stomach contents to move back into the esophagus. Your doctor may recommend appropriate follow-up and treatment if reflux symptoms develop.

Is POEM Safe?

POEM is an advanced endoscopic procedure and, like any medical procedure, can have potential risks. These may include bleeding, infection, leakage, inflammation, or other complications. Acid reflux can also occur after treatment.

However, careful patient selection, appropriate preparation, advanced endoscopic equipment, and experienced medical care are important in minimizing risks.

Patients should discuss the potential benefits and risks with their treating specialist before undergoing the procedure.

Why Choose Expert POEM Care?

POEM requires specialized endoscopic equipment, detailed knowledge of esophageal anatomy, and expertise in advanced therapeutic endoscopy. Accurate diagnosis and appropriate patient selection are equally important for achieving successful treatment.

If you have persistent difficulty swallowing, frequent regurgitation, or have been diagnosed with achalasia, an expert evaluation can help determine whether POEM may be suitable for you.

POEM offers a modern, minimally invasive approach to treating achalasia by directly addressing the abnormal esophageal muscle and helping restore easier passage of food into the stomach. With appropriate evaluation and expert care, it can provide meaningful improvement in swallowing and quality of life for carefully selected patients.