By Jose Vega Peralta, MD, a Gastroenterologist at MNGI Digestive Health
What is POEM?
POEM stands for peroral endoscopic myotomy. It is a minimally invasive procedure performed using an endoscope, a thin, flexible tube with a camera, that is passed through the mouth and into the gastrointestinal (GI) tract.
During the procedure, the physician creates a small opening in the inner lining of the GI tract and carefully advances the scope into deeper muscle layers. From there, specific muscles that are too tight or do not function properly are precisely cut. These abnormal muscles are often the root cause of swallowing or motility problems.
Because POEM is done entirely from inside the body, no external incisions are needed, which helps reduce pain and recovery time.
Why was POEM developed?
POEM was originally developed to treat achalasia, a rare but serious swallowing disorder.
In achalasia, the muscles of the esophagus, especially the lower esophageal sphincter, fail to relax. This prevents food and liquids from moving normally into the stomach. Over time, patients may experience worsening difficulty swallowing, regurgitation, chest discomfort, coughing, weight loss, and malnutrition.
Before POEM, the primary treatment option was surgical myotomy performed through the abdomen or chest. While effective, surgery involved incisions, longer hospital stays, and more recovery time. POEM was developed as a less invasive way to treat the same muscle problem while achieving similar or better outcomes.
How does POEM differ from traditional surgery?
The most important difference is how the muscles are accessed.
Traditional surgery:
- Requires incisions in the abdomen or chest
- Often involves longer hospital stays
- Can result in more post-procedure pain
- Carries risks associated with surgical wounds and healing
POEM:
- It is performed entirely through the mouth
- Leaves no visible scars
- Typically results in shorter hospital stays
- Allows for faster return to daily activities and diet
- Preserves normal anatomy
- Significantly less postprocedural pain
For many patients, POEM offers an effective alternative to surgery with fewer disruptions to daily life.
What conditions can POEM treat?
Although POEM was first developed for achalasia, its success led physicians to apply the same technique to other GI motility disorders.
Conditions that may be treated using POEM or POEM-based techniques include:
- Achalasia, including all subtypes
- Gastroparesis, where the stomach empties too slowly
- Zenker diverticulum, a pouch that forms in the throat due to muscle dysfunction
- Cricopharyngeal bar, a tightening of the upper esophageal muscle that causes swallowing difficulty
- Certain submucosal or deep-layer lesions within the GI tract can be removed without open surgery
Each condition requires careful evaluation to determine whether POEM is appropriate.
Who may be a good candidate for POEM?
Patients who may benefit from POEM often:
- Have symptoms caused by abnormal muscle function
- Have not responded well to medications or less invasive treatments
- Are seeking an alternative to traditional surgery
Candidacy depends on several factors, including symptom severity, diagnostic test results, overall health, and prior treatments. Not every patient with swallowing or motility symptoms will need POEM, but for the right patient, it can be life-changing.
Who performs the POEM procedure?
POEM is performed by a few highly trained physicians, most commonly gastroenterologists who have completed additional subspecialty training in advanced endoscopy and third-space endoscopy.
Because POEM involves working within deep layers of the GI tract, it requires specialized expertise and experience. For this reason, the procedure is usually performed at centers that focus on complex endoscopic and motility disorders.
Where is POEM performed?
POEM is performed in a hospital setting. This allows access to:
- Anesthesia services
- Specialized endoscopic equipment
- Post-procedure monitoring
- Immediate medical support if needed
Most patients stay in the hospital for observation, often overnight, to ensure safe recovery.
What testing is needed before POEM?
Before POEM, patients usually undergo a thorough evaluation to confirm the diagnosis and determine whether the procedure is appropriate. This may include:
- Upper endoscopy
- Esophageal manometry to measure muscle function
- Imaging studies, such as barium swallow tests
- Review of symptoms and medical history
These tests help ensure that POEM is targeted to the correct muscle problem and offers the best chance of symptom improvement.
What happens during the POEM procedure?
POEM is performed under general anesthesia, so patients are asleep and comfortable. The procedure typically takes one to two hours, depending on the condition being treated.
During POEM:
- The endoscope is passed through the mouth
- A small entry point is created in the GI lining
- The scope advances into the muscle layer
- Targeted muscles are carefully cut
- The entry site is closed using endoscopic clips
No external cuts or stitches are required.
What is recovery like after POEM?
Recovery after POEM is generally quicker than recovery from traditional surgery.
Most patients:
- Begin walking the same day
- Experience mild to moderate discomfort rather than severe pain
- Start with a liquid diet before progressing to soft and then regular foods
- Return to normal activities within days to weeks
Diet progression is important to allow proper healing, and patients receive clear instructions from their healthcare team.
Are there risks or side effects?
As with any medical procedure, POEM carries some risks. These may include:
- Bleeding
- Infection
- Air leakage into the surrounding tissues
- Development of acid reflux symptoms
One of the more common long-term effects is gastroesophageal reflux, which can usually be managed with medications and lifestyle adjustments. Your doctor will discuss risks in detail and explain how they are minimized.
Why is POEM important for patients and healthcare providers?
POEM represents a major advancement in GI care because it treats the underlying muscle problem directly while avoiding traditional surgery.
For patients, POEM offers:
- Symptom relief when other treatments fail
- Faster and less painful recovery, and fewer lifestyle disruptions
- Improved ability to eat and maintain nutrition
- Better overall quality of life
For healthcare providers, POEM expands treatment options for complex motility disorders and allows for precise, minimally invasive therapy.
What questions should patients ask their doctor?
Patients considering POEM may want to ask:
- Am I a good candidate for POEM?
- What condition is causing my symptoms?
- What tests do I need before the procedure?
- How experienced is the provider in performing POEM?
- What risks should I be aware of?
- What will recovery and diet progression look like?
- Will I need long-term follow-up or medications?
Open communication helps patients feel informed and confident in their care.
What key points should patients know about POEM?
- POEM is a well-established, evidence-based procedure
- It is not considered experimental
- Outcomes are best when performed by experienced providers
- Many patients experience significant, long-lasting symptom improvement
Understanding these points helps patients make informed treatment decisions.
What is the main takeaway?
POEM is a minimally invasive procedure that has transformed care for swallowing and motility disorders. By addressing abnormal muscle function directly, it offers effective symptom relief with less recovery time than traditional surgery.
What should patients do next?
If you or a loved one experiences persistent difficulty swallowing, nausea, vomiting, chest discomfort, or unexplained weight loss, it is important to seek evaluation. Consult a gastroenterologist experienced in advanced endoscopic procedures to determine whether POEM may be right for you. Early diagnosis and the right treatment can make a meaningful difference in long-term health and quality of life. Schedule an appointment with MNGI Digestive Health today!
Disclaimer: This blog post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
