Overview
POEM (Peroral Endoscopic Myotomy) is an endoscopic procedure used to treat swallowing disorders, most commonly for achalasia. POEM is a relatively new procedure that uses endoscopic technology and stands for Peroral Endoscopic Myotomy. This is an in-patient procedure and can take between one to three hours to complete.
Achalasia and other swallowing disorders are usually caused by the esophagus muscles and the lower esophagus sphincter muscles not relaxing, making it hard to swallow and hard for the food to pass into the stomach. Other symptoms besides swallowing issues may be heartburn, weight loss and an overall low quality of life.
Endoscopes are flexible tubes that can be passed through the mouth or rectum. They allow physicians to see and examine the surfaces of the esophagus (food pipe), stomach, intestine and colon without making a large incision elsewhere on the body.
A benefit of having an endoscopic procedure, especially for swallowing disorders, is that there are no incisions in the chest or abdomen and includes a minimal or sometimes no hospital stay post-procedure.
Currently there are only a handful of centers in the United States offering this less-invasive approach to treating swallowing disorders. The technique originated in Japan and it has been performed in the United States for the past one to two years.
The Procedure
Before the procedure
Prior to your procedure, your doctor will discuss all the specific preparations you will need to follow. To prepare for the surgery, you will be placed on a liquid diet for two days and not allowed to eat or drink anything for 12 hours before the actual procedure. Fasting keeps your esophagus and stomach clear for the endoscope to pass.
Discuss any medications you may be taking with your doctor prior to prep.
The day you arrive at the hospital you will go through a series of examinations prior to being prepped for the procedure.
During the procedure
Once you are all set, you will be wheeled into the operating room and given an IV with anesthesia and antibiotics. The procedure is performed under general anesthesia and you will be completely asleep. Once you are asleep the team will begin.
During the procedure an endoscope tube is inserted into your mouth and down your esophagus. There will be a small camera placed on the end of the tube and the physician will be able to control where the endoscope tube goes by watching a TV monitor next to him or her.
The endoscope tube tunnels into the lining of the esophagus muscles and makes a pathway. A special knife is then attached to the end of the endoscope tube and tunnels into the new pathway. The knife cuts away and loosens the tight esophagus muscles that are causing the swallowing problems. The knife cuts and loosens the muscles on the side of the esophagus, the lower esophagus sphincter and the upper part of the stomach. Once this is complete, endoscopic clips are inserted at the lining of the esophagus to keep the incision at the top closed. The endoscope tube is then removed by coming back up through your mouth.
The procedure relieves the tightness and allows the esophagus to empty like it normally should to pass food down into the stomach.
Recovery
You will usually stay in the hospital overnight to make sure there are no complications. You may not eat anything post surgery.
You will be admitted to the hospital afterwards and most patients stay for less than one day. The morning after the procedure, you will undergo a barium X-ray to ensure that the esophagus muscle is open and that there is no leakage. You will be started on a liquid diet and likely discharged from the hospital that day.
Follow-up care includes meeting with your surgeon as an outpatient seven to 10 days after you have the procedure done. Then you will come in again around the three month mark for another swallow study to make sure your esophagus empties well.
Contact the Team
To find out more about POEM Treatment at Cleveland Clinic, please call 216.444.6664 or contact any of the following experts:
Nutrition
Nutrition services and lifestyle changes regarding swallowing disorders
Our Center for Human Nutrition is part of our Digestive Disease Institute. Nutrition plays a large role in treating the symptoms of having an esophagus or swallowing disorder. Our Center is one of the only centers in the nation offering comprehensive services, including specialized teams for nutrition therapy, intestinal rehabilitation and nutrition support.
Treatment options for swallowing disorders often times includes working with our Center for Human Nutrition.
