Peroral Endoscopic Myotomy

Peroral endoscopic myotomy (POEM) is a minimally invasive procedure used to treat patients with achalasia.

What is POEM?

Peroral endoscopic myotomy (POEM) is an advanced endoscopy procedure that provides relief from symptoms of achalasia, such as chest pain, difficulty swallowing, and regurgitation.

Why is POEM performed?

Achalasia occurs when the juncture between your esophagus and your stomach, the lower esophageal sphincter (LES), cannot relax properly, affecting the passage of food into the stomach. The goal of POEM is to relax your LES by creating a small incision in its inner layer of muscles.

How do I know if I am a candidate for POEM?

Once your achalasia diagnosis has been confirmed, your physician will review your symptoms and your medical history to determine if POEM is right for you.

You may be a candidate for POEM if one of the following applies to you:

• You have been diagnosed with achalasia
• Previous attempts to manage your symptoms of achalasia through medication or surgery have proven ineffective

What can I expect during POEM?

Your care team will provide you with detailed information about what to expect before, during, and after the POEM procedure.

Preparing for POEM

You will be asked to refrain from eating or drinking beginning at midnight before your procedure. To ensure you are not conscious during the procedure, you will be administered general anesthesia before undergoing POEM.

The POEM Procedure

POEM is performed using an endoscope, a thin, flexible tube with a camera attached. During the procedure, your doctor will first cut through the mucosa, the innermost layer of esophageal tissue, using a tiny knife connected to the endoscope. Then, your doctor will create a tunnel through the submucosa, the second-innermost layer of esophageal tissue. Next, a small incision will be made in the muscle fibers surrounding the esophageal wall, and the outer portion of the esophagus will not affected. Finally, your doctor will remove the endoscope through the submucosal tunnel and close the mucosal incision.

What can I expect after undergoing POEM?

After your POEM procedure, your care team will identify any esophageal leakage caused by the treatment using a specialized X-ray examination known as an esophagram.

While some return home the day of their POEM procedure, others may be asked to stay overnight at the hospital. After your procedure, you will be instructed not to eat or drink anything for the rest of the day and to begin a clear liquid diet the following day. Soft foods can be introduced on subsequent days as you work your way up to returning to your regular diet. You may be prescribed a course of antibiotics in the days immediately following your procedure.

As POEM is a minimally invasive procedure, recovery times after POEM are relatively short. A follow-up endoscopy will be scheduled 1-2 months after your procedure to assess your recovery. Your doctor may recommend additional visits based on the specifics of your condition.

Some patients may develop symptoms of gastroesophageal reflux disease (GERD) after undergoing POEM. While this and other adverse events are uncommon, your doctor will work with you to manage any complications associated with your procedure.

Most patients report long-term achalasia relief after POEM. In a follow-up study of over 100 POEM patients, nearly 90% of participants demonstrated an improvement in LES function four years or more after their treatment.

Care Team Approach

Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, takes a multidisciplinary approach to your care. This means you will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include gastroenterologists, surgical and non-surgical heartburn and esophageal disorders specialists, physician assistants, nurses, advanced practice providers, dietitians, social workers, and more, providing unparalleled care for patients every step of the way.

We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with your other healthcare providers to ensure that we are providing you with comprehensive, whole-person care.

Learn More About Your Care Team