Peroral Endoscopic Myotomy (POEM) is an innovative minimally invasive, endoscopic procedure targeted at patients with achalasia, an uncommon esophageal motility condition which makes swallowing difficult. The treatment for peroral endoscopic myotomy was introduced in the first quarter of 2010 in the early 2010s, the POEM procedure is a better alternative to conventional surgical techniques which reduces the time to recover and improving the outcomes of patients.
What is Peroral Endoscopic Myotomy (POEM)?
POEM is a sophisticated endoscopic procedure that is that is performed with general anesthesia. It uses an endoscope with a flexible design that passes through the mouth to access the stomach. The doctor makes tiny cuts within the lining of the esophagus. This cut the muscles that are which are responsible for contraction and ailment.
The aim of the procedure is to permit liquids and food items to move more easily through the stomach into the esophagus and provide long-lasting relief from the symptoms of achalasia, such as:
- Dysphagia (difficulty swallowing)
- Regurgitation of food that is not digested
- Chest pain
- Acid reflux or heartburn
- Weight loss
Why is POEM Used?
The procedure is Treatment for Peroral Endoscopic Myotomy is primarily used to treat achalasia but it’s also useful for other disorders of the esophageal spasm such as:
- Diffuse esophageal spasm
- Jackhammer Esophagus
- Esophagogastric obstruction of the junction’s outflow (EGJOO)
POEM is frequently recommended for:
- Botulinum injections or medications do not work
- Pneumatic dilation isn’t effective.
- Patients favor a less surgically
How the POEM Procedure is Performed
Here’s a step-bystep outline of the POEM procedure:
- Preparation:- The patient receives general anesthesia. There are no incisions on the outside which makes it virtually unnoticeable.
- Accessing the Esophagus:- A flexible endoscope is introduced through the mouth, and then navigated down the esophagus.
- Creating a Tunnel:- Small cuts are cut in the mucosal tissue to create a tunnel in the esophageal wall into the lower esophageal sinus (LES).
- Cutting the Muscles:- The fibers of the circular muscles that cause tightness are cut in a selective manner (myotomy) and relax the esophagus.
- Closing the Tunnel:- The entrance point is securing with clips that disappear on their own within a couple of hours or even weeks.
The complete POEM process takes between 60 to 90 minutes dependent on the how complex.
Benefits of the POEM Procedure
Patients who undergo surgery for Peroral Myotomy enjoy many advantages:
- Very minimally invasive: No cuts or scars on the outside.
- Rapid recovery: Most patients eat again within just a few days
- Long-term relief of symptoms High success rate (>90 percent) in reducing symptoms of achalasia
- Postoperative pain less
- Short hospital stay (often 1-2 days)
Who is a Candidate for POEM?
You might be a good candidate for POEM If you
- Manometry has confirmed that achalasia is present or endoscopy. Imaging
- Are not responding to other treatments like pneumatic dilation or Botox
- Would you prefer a less-invasive alternatives to Heller myotomy
- Recurrence of symptoms following previous achalasia treatments
The gastroenterologist will examine your health history, your age the severity of your symptoms and esophageal function tests, before making a recommendation for POEM.
Risks and Complications of POEM
While POEM typically is safe some of the potential dangers are:
- Gastroesophageal reflux disorder (GERD) is a condition in which the lower esophageal and sphincter are weak, acid reflux can be experienced post-operatively. In the long run, acid suppression using PPIs might be necessary.
- Bleeding or perforation: Very rare However, it is likely
- Infections: Preventable by using antibiotics
- The subcutaneous emphysema, also known as pneumothorax The condition is rare and often self-resolving.
The chance of developing serious complications is minimal particularly in centers with experience.
Recovery After POEM Surgery
The recovery from treatment for Peroral endoscopic Myotomy can be fairly quick.
- Hospitalization: 1-2 days
- Diet: Begin with clear liquids, then progress to soft food items over the course of a week
- Activity: Resume normal activities within a couple of days
- Monitoring via manometry or esophageal pH may be needed
Many patients notice significant improvement in their swallowing abilities and quality of life within a few weeks after the procedure.
Success Rate and Long-Term Outlook
Research has shown that POEM has an overall effectiveness rate of more than 90 percent. The relief from symptoms is usually sustained for many years, but some patients may require medications to treat acid reflux.
POEM has continued to increase its acclaim because of its:
- High success rate
- Risk of complication is low
- Excellent patient satisfaction
Conclusion
The treatment for Peroral Endoscopic Myotomy has redefined the treatment of achalasia and related esophageal problems. It is a combination of precision, efficacy and minimal invasiveness, making it the ideal choice for a large number of patients. If you’re having constant swallowing difficulties and you’ve been diagnosed with achalasia then talk to a gastroenterologist, or an endoscopic surgeon to determine if POEM is the best option for you.
