June 30, 2024

Poem Procedure: Innovative Relief for Achalasia Sufferers

Peroral endoscopic myotomy (POEM) is a minimally invasive procedure aimed at treating achalasia, a disorder which hinders the esophagus from effectively moving food into the stomach. This innovative technique is also used to manage other swallowing difficulties.

Understanding Achalasia

Achalasia occurs when the muscles of the esophagus fail to contract properly and the lower esophageal sphincter (LES) does not relax as it should, making it difficult for food to pass from the esophagus into the stomach. Common symptoms include difficulty swallowing, chest pain, regurgitation of undigested food, and significant weight loss.

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What is POEM?

Procedure Overview

POEM is an endoscopic therapy that offers an alternative to conventional surgical treatments, such as the Heller myotomy, by using an upper endoscope. The primary goal of POEM is to weaken the lower esophageal sphincter to alleviate the symptoms of achalasia.

During the procedure, a flexible endoscope is passed through the mouth into the esophagus. A small incision is made in the innermost layer of the esophagus to create a submucosal tunnel. The endoscope then tunnels down to the lower esophagus to cut the muscle fibers of the lower esophageal sphincter. Finally, the incision is closed.

Eligibility and Preparation

Patients experiencing difficulty swallowing due to achalasia could be potential candidates for POEM. Alternative treatments include pneumatic dilation, Heller myotomy, and botulinum toxin injection. Prior to the procedure, patients must follow specific preparations including a liquid diet, fasting, and possibly taking antibiotics.

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Recovery and Follow-Up

Post-procedure, patients usually spend the night in the hospital for observation. They will undergo an esophagram to check for complications, follow a specific diet plan, and take acid-reducing medications. Follow-up appointments are crucial to monitor recovery and communicate results to the referring physicians.

Benefits and Risks

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Advantages of POEM

POEM is a less invasive treatment method compared to traditional surgeries, offering quicker recovery times and similar success rates. Around 90% of patients experience significant relief from symptoms, and the absence of external incisions minimizes the risk of infection and other complications.

Potential Complications

Despite its numerous benefits, POEM is not without risks. Potential complications include bleeding and esophageal perforation. Patients should contact their doctor if they experience symptoms such as severe chest pain or difficulty swallowing after the procedure.

The Evolution of POEM

The less-invasive POEM technique originated in Japan and has gained popularity in the United States over the past few years. The use of flexible endoscopes allows for detailed examination and treatment of the esophagus without requiring large incisions, significantly reducing recovery times for patients.

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In summary, POEM is a groundbreaking procedure offering significant benefits for patients suffering from swallowing disorders like achalasia. With its minimally invasive approach, high success rates, and reduced recovery period, POEM stands out as an effective alternative to traditional surgical treatments.

Aspect Description
Procedure Name Peroral Endoscopic Myotomy (POEM)
Treated Condition Achalasia
Approach Minimally invasive, uses an upper endoscope
Main Goal To weaken the lower esophageal sphincter (LES)
Eligibility Patients with swallowing difficulties due to achalasia
Preparation Liquid diet, fasting, possibly antibiotics
Recovery Hospital observation, specific diet plan, acid-reducing medications
Success Rate Approximately 90%
Advantages Less invasive, quicker recovery, high success rate, minimal external incisions
Potential Complications Bleeding, esophageal perforation, severe chest pain, difficulty swallowing

Frequently Asked Questions (FAQ) About POEM

What is peroral endoscopic myotomy (POEM)?

Peroral endoscopic myotomy (POEM) is a minimally invasive procedure designed to treat achalasia and other swallowing difficulties. It involves using an endoscope to cut the muscle fibers of the lower esophageal sphincter to improve food passage from the esophagus into the stomach.

What is achalasia?

Achalasia is a disorder where the muscles of the esophagus do not contract properly, and the lower esophageal sphincter (LES) fails to relax, making it difficult for food to pass into the stomach. Symptoms include difficulty swallowing, chest pain, regurgitation of undigested food, and significant weight loss.

What are the steps in the POEM procedure?

The POEM procedure involves several steps:

  • A flexible endoscope is passed through the mouth into the esophagus.
  • A small incision is made in the innermost layer of the esophagus to create a submucosal tunnel.
  • The endoscope tunnels down to the lower esophagus to cut the muscle fibers of the lower esophageal sphincter.
  • Finally, the incision is closed.

Who is eligible for POEM?

Patients experiencing difficulty swallowing due to achalasia may be candidates for POEM. Other treatment options include pneumatic dilation, Heller myotomy, and botulinum toxin injection. Eligibility and preparation should be discussed with a healthcare provider.

How should patients prepare for the POEM procedure?

Prior to the procedure, patients need to follow specific preparations including adhering to a liquid diet, fasting, and possibly taking antibiotics to minimize infection risk.

What is the recovery process like after POEM?

After the POEM procedure, patients generally spend one night in the hospital for observation. They will undergo an esophagram to check for complications, follow a specific diet, and take acid-reducing medications. Follow-up appointments are essential to monitor recovery and ensure proper communication with the referring physician.

What are the benefits of POEM?

POEM offers several benefits including being less invasive than traditional surgeries, quicker recovery times, and similar success rates. Approximately 90% of patients experience significant symptom relief, and the absence of external incisions reduces the risk of infection and other complications.

What are the side effects of POEM surgery?

While POEM has numerous benefits, it is not without risks. Potential side effects include bleeding and esophageal perforation. Patients should seek immediate medical attention if they experience severe chest pain or difficulty swallowing post-procedure.

How has POEM evolved over time?

POEM originated in Japan and has become increasingly popular in the United States over recent years. The use of flexible endoscopes allows for detailed examination and treatment of the esophagus with significantly reduced recovery times, offering an effective alternative to traditional surgical methods.

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