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Healthcare: Respiratory & Lung Care (Pulmonology)

Peroral Endoscopic Myotomy (POEM)

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Scott Holmes
Peroral Endoscopic Myotomy (POEM)
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The POEM procedure is performed by endoscope. There is no incision in the chest or abdomen. The endoscope (a thin flexible tube) is passed through the patient's mouth into the esophagus. Using a blade on the end of the scope, an incision is made in the lining (mucosa) of the inside of the esophagus and the scope is passed through into the space created between this mucosal layer and the muscular layers of the esophagus.

The POEM procedure is done to treat the swallowing disorder known as achalasia.

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What Is Achalasia?

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Achalasia is a disorder of motility in the esophagus in which the esophagus has lost its normal ability to move food and liquids down into the stomach. In addition, the lower esophageal sphincter, the muscular ring that controls food passing from the esophagus to the stomach, doesn’t relax properly to let food and liquids into the stomach.

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Symptoms of Achalasia

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  • Difficulty in swallowing
  • Chest pain
  • Heartburn
  • Weight loss
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How Is the POEM Procedure Performed?

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The POEM procedure is performed by endoscope. There is no incision in the chest or abdomen. The endoscope (a thin, flexible tube) is passed through the patient's mouth into the esophagus. The surgeon cuts away some of the muscles that encircle the esophagus, lower esophageal sphincter and stomach, relaxing the pressure on the esophagus and allowing food to pass into the stomach with less resistance. The small incision is closed using endoscopic clips, and the endoscope is withdrawn from the patient.

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How Does POEM Compare to Standard Surgical Procedures to Treat Achalasia?

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Outcomes are comparable to the Heller myotomy, which is the gold standard. Heller is equivalent to balloon dilation. However, dilatation requires repeat interventions, has some anatomical limitations and risk of perforation. Though repeat surgical intervention isn't common with achalasia, POEM makes it easier to re-intervene if needed.

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What Is the Future of POEM?

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It will likely replace the Heller myotomy as the surgical gold standard within the next three to five years.

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Outlook

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Patients may need to take life-long acid reflux medications.

Unlike balloon dilatation, which requires repeat interventions, repeat surgical intervention isn't common with a POEM procedure, and since it is a less invasive way of accomplishing a myotomy, a POEM procedure makes it easier to re-intervene if necessary.