A minimally invasive procedure used to treat swallowing disorders, such as achalasia, by relaxing the muscles of the esophagus.
What is POEM?
Per-oral endoscopy myotomy, or POEM, is performed to treat swallowing disorders not responding to medical therapies- most commonly achalasia. It is a type of endoscopic surgery used to cut muscles in the GI esophagus, allowing for the passage of food and liquids in patients with swallowing disorders. The entire procedure is done without any external incisions.
Before the procedure:
Your medical history will be reviewed with you by your health care team including a nurse, your gastroenterology physician and an anesthesia provider. An IV line will be placed, as well as an arterial line to monitor your blood pressure.
During the procedure:
During your procedure, the anesthesia provider will administer medications and monitor vital signs while you are under general anesthesia. Your doctor will pass the endoscope through your mouth and into the esophagus while observing images on a monitor. An initial incision will be made for entry of the endoscope to within the wall of the esophagus, where the muscle will be exposed. The inner layer of the muscle near the lower esophageal sphincter will be cut (this is termed myotomy). At the conclusion of the procedure, the esophageal incision will be closed with standard endoscopic clips. The procedure takes roughly 2 hours, and patients usually spend 1-3 days in the hospital.
What happens after the procedure?
At the end of the procedure, you will be taken to a recovery area. The physician will talk with you about the initial results of your procedure and will prepare a full report, which will be given to you and the healthcare provider who referred you for POEM. You will be admitted to the hospital for monitoring and antibiotics. You will continue to fast on the night of the procedure. An X-ray (barium) swallow study is usually performed prior to resuming oral intake. During your stay in the hospital (usually 1-2 days), your diet will be advanced according to your providers instructions. Additional instructions will come from your provider prior to your discharge home. You will have an appointment 1 week after the procedure to check your progress and discuss your diet. 3 months after the procedure you will have a follow-up office visit and esophogram study.
Are there possible complications from POEM?
Although serious complications are rare, any medical procedure has the potential for risks. Risks from POEM include perforation, bleeding, reactions to medications, heart and lung problems, and dental or eye injuries.
