Peroral Endoscopic Myotomy (POEM) is a modern, minimally invasive treatment designed to address achalasia, a swallowing disorder. Achalasia is characterized by the failure of the lower esophageal sphincter (LES)—a ring of muscle connecting the esophagus and stomach—to relax properly, combined with poor movement in the rest of the esophagus. This combination creates a functional obstruction, making it difficult for food and liquids to pass into the stomach. This timeline breaks down the duration of the POEM process, detailing the surgical mechanics and the necessary post-procedure logistics.
Understanding the POEM Procedure
POEM is an endoscopic approach, performed entirely through the mouth using a flexible, specialized tube called an endoscope. This method avoids the external incisions required for traditional surgical myotomies. The primary objective is to weaken the overly tight muscle fibers of the LES so that the passage of food is no longer restricted.
The process begins with the patient under general anesthesia. The endoscopist guides the instrument down the esophagus, creating a small incision in the inner lining, known as the mucosa. This opening allows access to the submucosal space, a layer of tissue situated beneath the lining.
A tunnel is then carefully created within this submucosal layer, extending down to and slightly past the LES. This tunneling technique allows the endoscopist to reach the muscle without disturbing the outer layer of the esophagus. Once the instruments are positioned within this tunnel, the inner, circular muscle fibers of the LES are precisely cut; this mechanical division is called a myotomy. After the muscle is cut to the desired length, the endoscope is withdrawn, and the initial mucosal incision is closed using specialized endoscopic clips.
The Surgical Timeline: Preparation to Procedure End
The total duration a patient spends in the operating suite is significantly longer than the actual endoscopic intervention time. The process begins in the pre-operative area, where nurses and anesthesiologists place intravenous lines, administer antibiotics, and review the patient’s history. Anesthesia induction and patient positioning require a dedicated period before the procedure formally starts. Accounting for the full cycle—from entering the operating room, through anesthesia, the procedure itself, and transfer to recovery—the patient should anticipate a total time commitment in the surgical area of approximately two to four hours.
For most patients, the time spent on the myotomy, tunneling, and incision closure falls within a range of approximately 60 to 120 minutes. The variability in this procedural time is influenced by the specific anatomy of the patient and the complexity of their achalasia. Cases involving very thick esophageal muscle, significant scar tissue from previous treatments, or unusual anatomical features may extend the necessary time. The experience and technical expertise of the operating team are also major factors, with centers performing many POEMs generally demonstrating shorter, more predictable procedural times.
Immediate Post-Procedure Recovery and Hospital Stay
Once the procedure is complete, the patient is moved to the Post-Anesthesia Care Unit (PACU) for immediate monitoring as they wake up from general anesthesia. This initial recovery period typically lasts between one and three hours, allowing the medical team to ensure the patient’s vital signs are stable and pain is well-controlled. Following this, the patient is admitted to a hospital room for observation.
The standard hospital stay after a POEM procedure is short, with most patients being discharged within 24 to 48 hours. A key step during this stay is a diagnostic imaging test, such as an esophagram, performed the morning after the procedure. This test involves swallowing a contrast dye, allowing doctors to confirm there are no leaks from the mucosal closure site before starting oral intake.
If the esophagram confirms the integrity of the esophagus, the patient can begin the first of several dietary milestones. They start with a clear or highly blenderized liquid diet, which they must tolerate before being cleared for discharge. Upon leaving the hospital, patients are instructed to continue a liquid diet for approximately one week, followed by a soft or pureed diet. Discharge also includes prescriptions for acid-reducing medication, such as a proton pump inhibitor, and often a short course of antibiotics to prevent infection.