Peroral endoscopic myotomy (POEM)

The POEM Procedure

During a POEM procedure, the patient is placed under general anesthesia to ensure comfort and safety throughout the intervention. The endoscope is then advanced through the mouth and into the esophagus, allowing the endoscopist to visualize the target area. Using specialized tools attached to the endoscope, the inner lining of the esophagus is carefully incised, followed by selective myotomy of the underlying muscle layers. This precise manipulation of esophageal tissue effectively disrupts the dysfunctional muscle fibers responsible for the impaired passage of food and liquids into the stomach.

Indications for POEM

POEM is indicated for patients with achalasia who have failed to respond to conservative treatments, such as medications or pneumatic dilation. It is particularly beneficial for individuals with type II or type III achalasia, as well as those with esophageal motility disorders characterized by hypertensive lower esophageal sphincters.

Benefits of POEM

The adoption of POEM offers several advantages over traditional surgical approaches, including:

• Minimally Invasive: POEM is performed entirely through the mouth, eliminating the need for external incisions and reducing the risk of postoperative complications, such as infection or wound healing issues.
• Improved Symptom Relief: POEM effectively disrupts the dysfunctional muscle fibers in the esophagus, leading to significant improvement in symptoms such as dysphagia, regurgitation, and chest pain.
• Faster Recovery: Compared to traditional surgical interventions, POEM is associated with shorter hospital stays, faster recovery times, and quicker return to normal activities.

Considerations and Complications

While POEM is generally considered safe and effective, there are potential risks and complications associated with the procedure, including bleeding, perforation of the esophagus, and postoperative reflux symptoms. However, with proper patient selection, skilled endoscopists, and adherence to established protocols, the risk of complications can be minimized, ensuring optimal outcomes for patients undergoing POEM.

In Conclusion

Peroral Endoscopic Myotomy (POEM) stands as a transformative treatment modality for achalasia, offering patients a minimally invasive alternative to traditional surgical interventions. With its ability to provide significant symptom relief, improve esophageal function, and enhance quality of life, POEM has emerged as a cornerstone in the management of achalasia, paving the way for improved outcomes and patient satisfaction.