Peroral endoscopic myotomy (POEM)

Peroral endoscopic myotomy (POEM) is an endoscopic therapy for achalasia. It uses upper endoscopy rather than conventional surgery, which involves an incision in the skin. In patients with achalasia, the lower esophageal sphincter is too tight. The goal of all treatment of achalasia is to weaken the lower esophageal sphincter.

How is POEM performed?

While the patient is under general anesthesia, the endoscopist passes the flexible endoscope through the mouth into the esophagus. A small incision is made in the innermost layer of the esophagus (the mucosa). The endoscope is then tunneled down the remaining length of the esophagus in the layer called the submucosa. In the lower esophagus, the endoscopist cuts the muscle fibers of the lower esophageal sphincter. The endoscope is removed and the first incision made in the mucosa is closed to complete the procedure.

Who needs POEM?

Patients with difficulty swallowing due to achalasia may be treated with POEM. Alternative treatments include pneumatic dilation, Heller myotomy (a traditional surgery), and botulinum toxin (Botox®) injection.

What are the potential complications of POEM?

POEM is generally a safe procedure. Rare complications include bleeding and a puncture (or perforation) in the lining of the esophagus. If you notice blood in your stool, black stool, fever, chills, vomiting, chest pain, stomach pain, or shortness of breath, contact your doctor as instructed on your discharge papers.

What do I need to do before POEM?

Your doctor will ask you to limit your diet to full liquids 3 days before the procedure, and then clear liquids 1 day (24 hours) before the procedure. You will be given a prescription for an antibiotic to take before the POEM procedure. Your doctor may alter your medicines.

What happens after POEM?

After the POEM procedure, you will be observed in the hospital overnight. An esophagram (X-ray of the esophagus) will be obtained the next day. You will be asked to consume a liquid diet for about 1 week, then soft food, advancing to a regular diet as tolerated. You will be given an acid-reducing medicine to take for 1 month after the procedure. The results of the procedure will be communicated to your referring physician(s).