POEM Procedure (Peroral Endoscopic Myotomy) for Achalasia Cardia

POEM Surgery Peroral Endoscopic Myotomy for Achalasia Cardia

What is POEM Procedure?

POEM stand for Peroral Endoscopic Myotomy procedure, in which Peroral means activity through the way of mouth, Endoscopic mean the use of endoscope to examine inside of body and Myotomy refers the incision made by the doctor.

POEM procedure is a minimally invasive therapeutic endoscopic procedure to treat severe swallowing disorders through the mouth and treating certain esophageal disorders by cutting the muscles.

This procedure is most commonly used for the treatment of achalasia cardia and spastic esophageal motility disorder.

What is Achalasia cardia & Spastic Esophageal Motility Disorder (EMD)?

Achalasia cardia is a rare disorder but common motility disorder making it difficult for food and liquid to pass into the stomach.

Achalasia cardia occurs when nerves in the esophagus are damaged.

As a result, the esophagus becomes numb, dilates over time, and eventually loses the ability to squeeze food into the stomach.

Spastic Esophageal Motility Disorder (EMD) is a disorder that’s characterized by uncoordinated contractions of the esophagus that can cause swallowing difficulties, muscles spasms or regurgitation of the food back to mouth.

There are different types of EMD such as diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter.

What is Gastric Peroral Endoscopic Myotomy procedure (G-POEM)?

Gastroparesis is a motility disorder that affects normal movement of the stomach muscles, resulting in improper emptying of the stomach.

It is usually found in patients with diabetes complications or surgery or some medicine that can slow down the stomach emptying process. This may result in nausea, vomiting, abdominal pain, bloating, weight loss, acid reflux etc.

How Gastroenterologists Selects Patient for POEM Procedure?

After having following investigations and diagnosis, patients suffering with swallowing difficulties are advised for the POEM procedure •

Esophageal Manometry – It is a test to assess motor function of the esophageal body, upper and lower esophageal sphincter. By doing this test doctor can differentiate the type of achalasia cardia type1, type 2 and type 3. It also diagnoses the spastic esophageal motility disorder.

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X-ray Barium Swallow - It is a radiology examination for the upper gastrointestinal (GI) tract. By this doctors can diagnose structural or functional issues of the upper GI tract.

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Upper GI Endoscopy - It is a non-surgical procedure used to find out the disease and conditions related to digestive system like difficulty swallowing, abdominal pain, gastritis, and ulcers, bleeding in digestive tract, bowel habit changes, colon growth or polyps.

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24 hour PH Metry – It is a test to assess 24 hours monitoring whether acid is coming back into the esophagus from the stomach causing pain, nausea, heartburn, and chest pain

What are the Advantages of POEM Procedure?

POEM procedure is a new endoscopic technique and have better results than Heller’s Myotomy (Laparoscopic Surgical Procedure) and Balloon Dilation (with a high recurrence rate).

Benefits of POEM procedure are as follows • • • • • • • •

Scar less endoscopic procedure Requires less sedation during procedure Shorter operative time Very minimal blood loss Shorter hospitalization Quicker recovery time Less risk of infection post procedure Effective in patients those previous surgeries was not successful

What Can a Patients Expect before POEM Procedure?

The procedure requires certain prerequisite that need to be followed by the patient before the POEM Surgery • Patients need to follow a liquid diet for at least 48 hours to clear the esophagus and stomach so that the procedure can happen smoothly.

• Patients are required to be fasting for 12 hours before the procedure.

In case of heart conditions or diabetes, patients are advised to discuss with the assisting doctors before taking medicines for preexisting diseases.

What Can a Patients Expect after POEM Procedure?

Post POEM Procedure a patients would experience the following situation and activities • doctor will monitor to make sure there are no complications.

• further to that after 24 to 48 hours doctor will do X-ray barium follow through test to confirm esophagus is open and there is no leakage happen afterwards.

• once everything is fine, the patient will be discharged, can go home, and follow the diet and medications as advised.