Peroral Endoscopic Myotomy or POEM is a procedure for treating swallowing disorders in some individuals caused by muscle disorders such as spasms in the oesophagus — the passageway between the mouth and stomach. POEM uses an endoscope, a narrow flexible tube with a camera, which is inserted through the mouth (peroral) to cut muscles in the oesophagus (a myotomy). Cutting the oesophagus's muscles loosens them and prevents them from tightening and interfering with swallowing.
It should be noted that in POEM, no incision is made through the patient's skin, which is why it is also not considered a surgery. It is a less invasive alternative to Heller myotomy, a similar procedure that reaches the oesophagus using small incisions instead of ingress through the patient's mouth. Compared to open surgical procedures, endoscopic procedures often mean less pain and a quicker recovery.
Why is the procedure performed?
POEM is primarily used to treat the condition of achalasia, an unrestrained tightness of the ring of muscle called the sphincter located between the oesophagus and the stomach. For individuals with oesophageal achalasia, the sphincter doesn't relax, and other oesophagus muscles are unable to help move swallowed food down, preventing it from entering the stomach. This disorder can cause choking, coughing, food becoming trapped in the oesophagus, sore throat, and even nutrient deficiencies and weight loss.
Individuals who experience low quality of life due to achalasia symptoms are excellent candidates for POEM. The procedure helps relieve achalasia by cutting the muscles in the lower part of the oesophagus, around the sphincter, and in the upper stomach. Doing so helps increase the space for food to pass into the stomach.
The procedure of POEM can also be used to treat other disorders that cause spasms in the oesophagus and fail to respond to drug treatment, such as a nutcracker or jackhammer oesophagus and diffuse oesophageal spasm. Book an appointment at our multi-speciality hospital today.
Age is usually not a significant factor, so both adults and children can have POEM. However, it can be risky if the patient has any underlying conditions such as heart and lung problems. The gastroenterologist may ask patients suffering from these conditions to get evaluated by an anesthesiologist before proceeding with POEM.
If the patient has had any previous surgeries on their oesophagus, that may also make POEM less effective or complicated for them. The doctor will discuss whether POEM is the best option for individuals in this case.
The doctor will insert an IV into the patient's vein to administer anaesthesia, fluids, and antibiotics.
Once the patient is unconscious from the anaesthesia, the doctor will pass the endoscope through the mouth and into the oesophagus and be able to view the inside of the oesophagus on a monitor.
They will then insert instruments through the endoscope to make a small cut in the patient's lower oesophagus lining. The doctor injects a liquid solution into this opening, and the endoscope works its way through to separate the lining from the muscle.
A myotomy (cutting of muscle) is performed along the tunnel that has been created. The muscle is cut in the lower oesophagus, the sphincter, and in the upper part of the stomach. Visit our Gastroenterology hospital in Yeshwanthpur, Bangalore to have the best treatment.
Using the endoscope, the doctor will close the incision in the oesophageal lining with small clips.
Risks and complications associated with POEM
POEM is a minimally invasive procedure and is regarded as safe. Although complications are rare, they are possible. These may include,
Gastro-oesophageal reflux disease (GERD)
Inflammation of the oesophagus
Bleeding due to injury to the oesophagus
An air bubble between the lungs (pneumomediastinum) or in the peritoneal cavity (pneumoperitoneum)
Collapsed lung (pneumothorax)