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Procedure Name

Peroral Endoscopic Myotomy (POEM)
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Surgery Type

Closed (Endoscopic)
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Hospital Stay

Nil (Outpatient)/ Overnight
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Duration of Surgery

2 to 3 hours
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Type of Anesthesia

General Anesthesia
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Full Recovery

2 to 3 months

Overview

Peroral endoscopic myotomy is a minimally invasive (less traumatic with faster recovery) procedure that helps treat achalasia (a form of swallowing disorder). Achalasia is an uncommon medical condition where the lower esophageal sphincter muscles (LES) abnormally tighten and fail to relax, not allowing foods and liquids to pass into the stomach.  

LES is a ring of muscles in the lower part of the esophagus (food pipe connecting the throat with the stomach) responsible for allowing foods to pass through it and enter the stomach. Peroral endoscopic myotomy (POEM) is the latest approach that uses an endoscope (a special device in the form of a long flexible tube that consists of a light source and a tiny camera at the tip) to treat swallowing disorders like achalasia. 

Read more about peroral endoscopic myotomy, its indications, procedure, benefits, and potential associated risks.

What is Peroral Endoscopic Myotomy (POEM)?

Peroral endoscopic myotomy (POEM) is an advanced, minimally invasive surgical procedure that treats achalasia by dividing the inner circular muscle layer of the LES into a tunnel and cutting the affected muscle (myotomy) to facilitate easy passage of food and liquids from the esophagus into the stomach. The entire procedure is performed using a flexible endoscope instead of large external incisions. The camera present at the tip of the endoscope captures images of the interior and projects them on a large screen that guides the surgeon to perform the surgery.

When is Peroral Endoscopic Myotomy (POEM) Recommended?

Peroral endoscopic myotomy is recommended in the treatment of achalasia which is caused due to damage to the surrounding nerves around the esophagus, impairing its normal function. The lower esophageal sphincter muscles are damaged, which eventually tighten and restrict the passage of food from the esophagus into the stomach. This leads to dysphagia (difficulty swallowing), chest pain, heartburn, GERD (gastroesophageal reflux disease), malnutrition, and weight loss. 

Other conditions treated by POEM include:

  • Distal esophageal spasm
  • Jackhammer esophagus
  • Nutcracker esophagus
  • Esophagogastric (EG) junction outflow obstruction

How to Prepare For a Peroral Endoscopic Myotomy (POEM)?

Before you undergo peroral endoscopic myotomy, you will need to undergo a series of diagnostic tests to evaluate your overall health, which include:

  • Chest X-ray
  • Endoscopy to check the severity of the condition affecting your esophagus
  • Ultrasound of the abdomen and pelvis
  • CT (Computed Tomography) scan

 To prepare you for the surgery:

  • Your surgeon will record your medical history for diseases like diabetes (increased blood sugar levels), heart diseases, and bleeding disorders to take the necessary precautions before and after the procedure.
  • You will be advised to discontinue certain medications like blood thinners, aspirin, and other herbal medications that may delay wound healing and prevent postoperative complications. 
  • You will be put on a 2-week liquid diet to reduce your weight before surgery and decrease the liver size to make the surgery safe.
  • You will be advised to abstain from smoking and alcohol for a period of 2 weeks before POEM.
  • You will be put on 12-hour fasting before POEM to keep your esophagus and stomach clear for the endoscope to pass easily.
  • You may need to arrange for someone to stay with you at the hospital if required.

How is Peroral Endoscopic Myotomy (POEM) Performed?

On the day of your surgery, you will be kept in the waiting area while your vitals (BP, blood sugar, pulse, heart rate, and oxygen levels) are checked.

  • You will be taken to the operating room, and the procedure will be performed under general anesthesia through intravenous administration to sedate you while you are asleep throughout the surgery. 
  • An endoscope will be inserted in your mouth through your esophagus, and the camera will capture the images and project them on a screen to guide the operating surgeon.
  • Your surgeon will guide the endoscope to pass through the esophagus. This will help make a tunnel pathway for inserting the surgical instruments.
  • A special knife will be attached to the end of the endoscope and inserted into this pathway.
  • The knife will cut and loosen the tight muscles of the esophagus, LES, and the upper part of your stomach.
  • The surgeon will then use endoscopic clips to close the incision at the top of the esophagus.
  • The endoscope will be retracted back through the mouth.
  • The entire procedure may take around 2 to 3 hours. 
  • You may be sent home the same day or advised of an overnight stay in the hospital.

What to Expect After a Peroral Endoscopic Myotomy (POEM)?

Peroral endoscopic myotomy is a safe procedure that helps you relieve symptoms of achalasia. After the surgery, you can expect the following:

  • You will be observed in a recovery room for an hour before being shifted to your room. While you are in the recovery room, your vitals will be continuously monitored.
  • Once you regain consciousness, you may experience pain and discomfort, especially in your throat, due to the insertion and retraction of the endoscope. This will be managed through pain relief medications.
  • You will be on IV fluids for the next 24 after the procedure. 
  • A special barium x-ray will be performed to ensure the esophageal muscle is open and there is no leakage.
  • Once the passage looks clear, you will begin a liquid diet the next day for at least 2 days post-surgery.
  • Once you are back home, you can begin a semi-solid diet with easily digestible foods from day 3 of your surgery. This should consist of blended or pureed foods for easy passage through the esophagus. You can eat anything provided it is well blended into a smooth consistency.
  • You will be instructed to avoid bread, spicy foods, citrus fruits and juices, carbonated and caffeinated drinks, alcohol, and smoking for at least 2 weeks post POEM, as this may hamper healing.
  • You will be advised to avoid any strenuous activities for at least 2 to 3 weeks after peroral endoscopic myotomy.
  • You should maintain good oral hygiene by regular brushing, flossing, and gargling with an antiseptic solution. This helps to prevent any bacterial invasion and infection that may pass on to the esophagus.
  • Recovery may take 3 to 4 weeks following POEM, but the esophagus may take 2 to 3 months to heal completely.

What are the Benefits and Risks of Peroral Endoscopic Myotomy (POEM)?

Peroral endoscopic myotomy is a safe and effective alternative to the traditional open myotomy with the following benefits and risks:

Benefits

  • Since it is a minimally invasive procedure, it causes less trauma to the surrounding structures.
  • Relieves symptoms of achalasia and improves your quality of life.
  • There are no external incisions or scarring.
  • Generally a painless procedure due to the administration of general anesthesia.
  • Shorter hospital stay with quick recovery.
  • POEM is used to treat a wide range of medical conditions.

Risks

  • Tears in the mucosal lining of the esophagus cause bleeding and perforation.
  • Causes lung collapse with breathing difficulties.
  • Inflammation of the esophagus (esophagitis) accompanied by high-grade fever (>104 F), chills, or body aches.
  • Pneumomediastinum (presence of air in the mediastinum, which is a space between the lungs).
  • Worsening of GERD causes severe acid reflux.
  • Visibility can be compromised when compared to open myotomy.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!

The power of Medfin in patient’s words

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“ Got to know about them from my friend. They got an appointment for only 299. Once the doctor confirmed that I needed the surgery they got me a fixed cost which included ALL the costs. No extra amounts were charged. Thank you Medfin”

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“ After my consultation with the doctor, MEDFIN representative got me a fixed package cost that included my mothers initial tests, surgery cost. They also gave me stockings free for Rs. 3000 post the surgery. They kept up their promise they made”

Radhika Iyer Mumbai 8 days ago
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