Peroral Endoscopic Mytomy (POEM) is a procedure performed to treat swallowing disorders caused by tension in the esophageal muscles or what is known as esophageal achalasia. This procedure is carried out using an endoscopic instrument that is inserted through the mouth.

Who may need a POEM procedure?
POEM is used to treat achalasia, excessive tension in the ring of muscle (sphincter) between the esophagus and stomach. Patients who have symptomatic, manometrically proven primary idiopathic achalasia are eligible candidates for POEM. POEM can also treat other disorders that cause spasms in the esophagus that are not successfully treated with drug therapy, such as diffuse esophageal spasm and jackhammer esophagus.

Preparation of POEM procedure
Patients who will undergo the POEM procedure will first do a liquid diet for couple of days and fasting period the day before the procedure.

What happens during the POEM procedure?
– An intravenous (IV) will be inserted into the patient vein to give fluids, anesthesia, and antibiotics.
– After the patient falls asleep due to anesthesia, the doctor will insert the endoscope through the mouth and into the esophagus and will view the images of the inside of the esophagus on a nearby monitor.
– Then, the doctor will pass an instrument through the endoscope to make a small incision in the lining of the lower esophagus. A liquid solution is injected into this opening, and the endoscope works its way through to separate the lining from the muscle.
– Next, the doctor will perform a myotomy (muscle cutting) along the tunnel that has been created. Muscles are cut at the bottom of the esophagus, the sphincter between the esophagus and stomach, and in the upper of the stomach.
– The doctor will use an endoscope to close the incision in the esophageal lining with small clips.

This article has been reviewed by Rabbinu Rangga Pribadi, MD, consultant of gastroenterohepatology

Source:
Peroral Endoscopic Myotomy (POEM) | Johns Hopkins Medicine
Kumbhari V, Khashab MA. Peroral endoscopic myotomy. World J Gastrointest Endosc. 2015 May 16;7(5):496-509. doi: 10.4253/wjge.v7.i5.496. PMID: 25992188; PMCID: PMC4436917.

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