POEM (Peroral Endoscopic Myotomy) is an advanced, minimally invasive procedure for treating certain esophageal conditions. This endoscopic technique is performed entirely through the mouth, allowing for targeted treatment of muscle disorders within the esophageal wall to alleviate swallowing difficulties. It represents a significant advancement in addressing these challenging conditions.
Understanding POEM Surgery
POEM stands for Peroral Endoscopic Myotomy, which precisely describes the nature of this procedure: “peroral” signifies access through the mouth, “endoscopic” refers to the use of a flexible tube with a camera, and “myotomy” denotes the cutting of muscle. This innovative approach is entirely incisionless, meaning no external cuts are made on the skin. POEM is primarily performed to alleviate swallowing difficulties caused by disorders affecting the muscles of the esophagus, the tube that carries food from the mouth to the stomach.
The main condition treated by POEM is achalasia, a rare disorder where the lower esophageal sphincter (LES) fails to relax properly and esophageal muscles do not contract effectively. This leads to food and liquid getting stuck, causing symptoms like difficulty swallowing, regurgitation, chest pain, and weight loss. POEM also addresses other spastic esophageal motility disorders, such as diffuse esophageal spasm and jackhammer esophagus, where uncoordinated muscle contractions impede food movement.
The POEM Procedure Explained
The POEM procedure begins with the patient under general anesthesia. An endoscope, equipped with a camera and specialized tools, is inserted through the mouth and guided into the esophagus. This allows the medical team to visualize the internal structures on a monitor.
Once the endoscope is in position, a small incision is made in the inner lining (mucosa) of the esophageal wall. Through this opening, the endoscope creates a tunnel beneath the mucosa to access the underlying muscle layers.
Using a tiny knife, the surgeon cuts the problematic muscle fibers in the lower esophagus, often extending into the upper part of the stomach. This cutting, or myotomy, relaxes the tight muscles, allowing food and liquid to pass more easily. After the myotomy is complete, the initial mucosal incision is closed using small clips. The entire process typically takes between one to three hours.
Advantages and Patient Considerations
POEM offers several benefits compared to traditional surgical methods. Its minimally invasive nature leads to less pain and a quicker recovery. Patients often experience a shorter hospital stay, sometimes just overnight, contributing to a faster return to daily activities. Clinical data indicates high success rates, with over 90% of achalasia patients experiencing symptom relief and approximately 80% of those with other spastic disorders showing positive responses.
While POEM is generally considered safe, some patient considerations and potential risks exist. One common concern is the development or worsening of gastroesophageal reflux disease (GERD) following the procedure, as the muscle cutting can affect the natural barrier to acid reflux. Other, though rare, complications can include perforation, bleeding, or infection. Air bubbles can form in the chest cavity or a collapsed lung may occur. Patient suitability for POEM is assessed carefully; while it can be performed on individuals of various ages, including children and the elderly, those with severe heart or lung conditions, significant liver disease, or certain blood clotting disorders may not be ideal candidates.
Recovery and Long-Term Expectations
Following a POEM procedure, patients typically remain in the hospital for observation, usually overnight or for up to two to three days. During this initial recovery period, pain is managed with medication, and antibiotics may be administered to prevent infection. Recovery involves a gradual progression of diet. Patients usually start with no food or drink for the first 24 hours, followed by a clear liquid diet for a few days, then a full liquid diet, and finally soft foods. This phased approach helps the esophagus heal.
Patients are encouraged to resume light activity soon after the procedure, with a gradual increase over the following weeks. Long-term expectations for POEM are generally positive, with most patients experiencing lasting relief from their swallowing difficulties and an improved quality of life. Regular follow-up appointments are important to monitor progress. Given the potential for post-procedure acid reflux, patients are often prescribed proton pump inhibitors (PPIs) to manage acid production.