Peroral Endoscopic Myotomy (POEM) Procedure

What is a peroral endoscopic myotomy (POEM)?

Peroral endoscopic myotomy (peh-oral-endo-scopic-my-O-toe-me), or POEM, is a common treatment for achalasia and other esophageal motility disorders. These disorders make it hard for you to swallow food.

In a POEM procedure, your healthcare provider uses tiny tools attached to a flexible tube (endoscope) to make small cuts in your esophageal muscles. The cuts loosen the muscles so food can move to your stomach from your esophagus. The procedure isn’t a type of surgery because providers don’t make cuts (incisions) in your skin.

POEM stands for: peroral (doing a procedure through your mouth), endoscopic (meaning it’s done with a flexible tube called an endoscope) and myotomy (the medical term for cutting muscles).

How should I prepare for a POEM procedure?

Your healthcare provider will give you detailed information and answer your questions. In general, you’ll:

• Follow a clear liquid diet for two days before the procedure.
• Stop eating and drinking anything for 12 hours before the procedure.

What happens during a POEM procedure?

First, your anesthesiologist gives you general anesthesia, so you’ll sleep during the procedure. You’ll receive anesthesia through an intravenous line (IV). You’ll also receive antibiotics through the IV. During the POEM procedure, your provider will:

1. Insert an endoscope into your mouth and down your esophagus — the endoscope will have a small camera at the end, which sends images of the inside of your esophagus to a monitor (your provider uses the images to guide the endoscope)
2. Make a cut in the mucosa (the inner layer) of your esophagus
3. Insert the endoscope into the mucosa and submucosa (a layer of connective tissue surrounding the mucosa)
4. Move the endoscope through your submucosa to get to muscles in your lower esophagus
5. Attach a tiny knife to the end of the endoscope
6. Use the knife to make cuts in muscles in your esophagus, lower esophageal sphincter and the upper part of your stomach
7. Place clips to close the cut in the mucosa
8. Remove the endoscope

The procedure may take one to three hours to complete.

What happens after a POEM procedure?

You’ll stay at the hospital overnight so your care team can watch for any complications. The next day, you’ll:

• Have a barium X-ray so your provider can confirm your esophageal muscle is relaxed and open.
• Start a liquid diet that you’ll follow for two days.

What are the benefits of the POEM procedure?

The most significant benefit is that your healthcare provider can treat conditions like achalasia without making large incisions (cuts) in your chest or belly.

How successful is a POEM procedure?

A recent study concluded POEM has an 88% clinical success rate. In this case, it means the POEM procedure loosened esophageal muscles. That study also found that 95% percent of people who had the procedure had significantly fewer issues with swallowing food.

What are the complications of a peroral endoscopic myotomy?

POEM complications are rare, but they can occur. Potential complications include:

• Bleeding
• Esophageal rupture
• Esophagitis
• GERD
• Perforation of the mucosa in your esophagus
• Pleural effusion
• Pneumonia
• Pneumomediastinum

What is the recovery time for a peroral endoscopic myotomy?

You’ll be able to go back to work seven days after your procedure. But that recovery time may be different if your job involves moving or lifting anything that weighs more than 10 pounds (4.5 kilograms). In that case, ask your provider when you should be able to return to work.

When can I start eating food?

You’ll start eating soft foods seven days after your procedure. You’ll eat low-fiber food that’s soft in texture for 10 days to two weeks.

What are necessary follow-up appointments?

You’ll have a follow-up appointment 10 days after your procedure. Three months later, you’ll have an esophagram. Your healthcare provider will do the test to see if your esophagus empties when you swallow.

When should I call my healthcare provider?

Contact your surgeon if you have symptoms after your procedure like:

• Chest pain
• Coughing up blood
• Feeling very weak or like you’re going to faint
• Fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher
• Poop that looks darker than usual, is black or reddish
• Sore throat