Per-Oral Endoscopic Myotomy (POEM)
What is POEM?
Per-oral Endoscopic Myotomy (POEM) is an endoscopic procedure to treat achalasia. Achalasia is a swallowing disorder where a muscle at the lower end of the oesophagus (food pipe) experiences a nerve spasm and is unable to open to let food pass into the stomach. This results in food sticking the oesophagus once swallowed and can be uncomfortable and even dangerous.
The most common symptoms of achalasia are difficulty in swallowing and regurgitation/vomiting of food and/or drink. You can read some achalasia patient experiences here.
POEM is carried out via endoscopy (a thin flexible tube with a camera on the end) which passes down the throat into the oesophagus. Once in place a special piece of equipment makes a 1cm cut into the inner layer of the oesophagus and then a further cut is made lenghthways into the stomach. This rectifies the swallowing symptoms and also the chest pain associated with achalasia.
POEM or conventional treatment?
There are two forms of treatment currently used in most UK hospitals which treat the muscles in the oesophagus responsible for the muscle spasms, However success rates vary and some will need to be repeated as frequently as every 3 months.
- Balloon dilation – A specialist doctor, such as a Gastroenterologist, uses endoscopy (camera down the throat) to position a balloon into the sphincter (to help it to stretch and dilate the muscle) making it work more effectively. Usually a patient will need two treatments a few weeks apart. More than 80% of patients have success, but for some symptoms can return and in up to 20% of cases it needs to be repeated again
- Botox injections – Performed via endoscopy, botulinum toxin (botox) is injected into the sphincter to help loosen the muscle. This is used very infrequently now as it often does not work or needs to be repeated every 3-6 months
- Heller myotomy – A surgeon cuts the muscle at the end of the oesophagus and top of the muscle (performed via an incision on the patient’s abdomen). These have high rates of success but is an invasive operation
Per-oral endoscopic myotomy (POEM) is a newer and far more effective permanent treatment for achalasia.
POEM is an endoscopic, incisionless and minimally invasive solution – and the procedure does not need to be repeated. In 90% of cases complete symptom resolution is achieved.
POEM is a minimally invasive procedure and, as it is not surgery, it is very safe. POEM is performed via endoscope which means no scars on the abdomen and a lower risk of complications than traditional myotomy surgery.
The POEM procedure takes just 60 minutes and most patients can expect to be discharged 24 hours after the procedure.
After the POEM procedure patients should not eat for 24 hours and then will need a liquid diet for 1 week and puree foods only the week after. Three weeks after the procedure patients should be able to eat normally and can expect to be symptom free and able to continue life as normal again.
Dr Rehan Haidry is an experienced Consultant Gastroenterologist who can help diagnose and treat achalasia. Dr Haidry specialises in the POEM procedure and has treated many achalasia patients successfully. Many describe it as a life changing experience. Read about POEM patient experiences in our patient hub.
The POEM procedure is currently available at the Cleveland Clinic Hospital in London and is covered by most private insurers.
Get In Touch
For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:
Tel: 0203 423 7609 | Email: firstname.lastname@example.org