POEM Procedure (Per Oral Endoscopic Myotomy)
POEM is an advanced endoscopic treatment mainly used for swallowing disorders such as Achalasia and severe esophageal spasm disorders.
It is a minimally invasive procedure done through the mouth using an endoscope, without any external cuts or stitches.
What is Achalasia?
Normally, food passes from the esophagus into the stomach through a valve called the Lower Esophageal Sphincter (LES).
In achalasia:
- The LES does not relax properly
- Esophageal muscles do not push food downward effectively
- Food gets stuck in the esophagus
This causes:
- Difficulty swallowing
- Vomiting/regurgitation
- Chest pain
- Weight loss
- Recurrent cough or aspiration
POEM helps by cutting the tight muscle fibers so food can pass easily into the stomach.
Full Form of POEM
- P – Per Oral (through the mouth)
- O – Endoscopic
- E – Endoscopic
- M – Myotomy (cutting muscle)
Conditions Treated With POEM
POEM is commonly done for:
- Achalasia
- Diffuse esophageal spasm
- Jackhammer esophagus
- Spastic esophageal motility disorders
- Some cases of failed previous achalasia treatment
Symptoms Suggesting Need for POEM
A patient may require evaluation for POEM if they have:
- Difficulty swallowing solids and liquids
- Food sticking in chest
- Regurgitation of food
- Weight loss
- Chest pain
- Repeated coughing at night
- Aspiration pneumonia
- Poor response to medicines
Tests Done Before POEM
Usually these tests are performed:
- Upper GI Endoscopy (OGD scopy)
-
Esophageal Manometry
- Measures pressure and movement of esophagus
- Barium Swallow / Timed Barium Study
- CT scan in selected cases
- Routine blood tests
How is POEM Procedure Performed?
Step-by-Step Procedure
The procedure is done under general anesthesia.
Step 1 – Endoscope Introduction
A flexible endoscope is passed through the mouth into the esophagus.
Step 2 – Small Mucosal Incision
A tiny cut is made in the inner lining of the esophagus.
Step 3 – Tunnel Creation
A tunnel is created between the layers of the esophagus wall.
Step 4 – Myotomy
The tight muscle fibers of the lower esophagus and LES are carefully cut.
Step 5 – Closure
The entry opening is closed with endoscopic clips.
Duration of Procedure
Usually:
- 1–3 hours
Hospital stay:
- Usually 1–2 days
Is POEM Painful?
- The procedure itself is painless because the patient is under anesthesia.
- Mild chest discomfort, throat pain, or bloating may occur afterward for a few days.
Recovery After POEM
Immediately After Procedure
- Patient is monitored overnight
- Liquid diet started after confirming no leak
Diet Progression
Typical progression:
- Clear liquids
- Full liquids
- Soft diet
- Regular diet gradually
Recovery Time
- Light activity: few days
- Office work: about 1 week
- Full recovery: around 2 weeks
Benefits of POEM
Advantages include:
- No external cuts
- Minimal pain
- Faster recovery
- Excellent relief of swallowing difficulty
- Very effective for achalasia
- Can treat long muscle involvement
Success rates are usually around 85–95%.
Possible Risks & Complications
Although generally safe, complications can include:
- Bleeding
- Infection
- Perforation
- Air leak into chest/abdomen
- Acid reflux (GERD)
- Chest pain
- Pneumonia
GERD after POEM is one of the more common long-term issues.
When to Contact Doctor After POEM
Seek urgent medical care if there is:
- Fever
- Severe chest pain
- Vomiting blood
- Breathing difficulty
- Persistent vomiting
- Severe abdominal pain
In Simple Words
POEM is a modern, minimally invasive endoscopic treatment that relaxes the tight food pipe muscles in achalasia, helping food pass easily into the stomach and improving swallowing and quality of life.
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