Peroral Endoscopic Myotomy (POEM)
Innovative treatment for swallowing and digestive disorders
The POEM procedure is a minimally invasive procedure. It is used to treat a group of disorders that affect the esophagus. The most common of these disorders is achalasia.
Watch: Understanding the POEM Procedure
Who Needs the POEM Procedure?
Doctors at IU Health use the POEM procedure to treat esophageal motility disorders (EMDs). These disorders occur when the squeezing of the esophagus is irregular, absent or not happening at the right time. The most well-described EMD is achalasia. Symptoms of achalasia include:
- Regurgitation
- Feeling like something is stuck in the throat or chest
- Heartburn
- Chest pain
When you eat, the muscle in your lower esophagus should relax to let food pass into the stomach. Patients with achalasia have a tight muscle called the lower esophageal sphincter. The muscle tightness makes it hard for liquids, foods and medications to pass through normally. This rare condition can happen at any age. Causes of this disease are not known.
Your doctor will conduct a series of tests to diagnose your digestive problems. You will discuss options for treatment. POEM is an excellent treatment option for some patients, but not all. Talking to your doctor about the right option for you is best.
How is the POEM Procedure Performed?
POEM is a minimally invasive procedure that is done in an operating room. You are put to sleep under general anesthesia.
While you are asleep, your doctor will insert a thin, flexible tube down into your throat. Then an incision is made and a tunnel created between the layers of the esophagus in order to reach the lower esophageal muscle that is tight. Once the tunnel is created, your doctor will create an incision (called myotomy) on the lower muscle. This is a permanent cut. It creates an opening for liquids and foods to pass freely.
How Long Does the POEM Procedure Take?
The procedure takes around an hour and a half to complete.
What are Benefits of POEM Procedure?
The main benefit from POEM is a faster recovery time. This procedure has no cuts or scars on the outside of the body. POEM is also safer for the following patients:
- Have had previous upper abdominal surgeries
- Have heart, lung or kidney problems
- Are morbidly obese
You can return to an active lifestyle faster with this less invasive method.
What to Expect with Peroral Endoscopic Myotomy (POEM)
Watch: Understanding the POEM Procedure
Who Needs the POEM Procedure?
Doctors at IU Health use the POEM procedure to treat esophageal motility disorders (EMDs). These disorders occur when the squeezing of the esophagus is irregular, absent or not happening at the right time. The most well-described EMD is achalasia. Symptoms of achalasia include:
- Regurgitation
- Feeling like something is stuck in the throat or chest
- Heartburn
- Chest pain
When you eat, the muscle in your lower esophagus should relax to let food pass into the stomach. Patients with achalasia have a tight muscle called the lower esophageal sphincter. The muscle tightness makes it hard for liquids, foods and medications to pass through normally. This rare condition can happen at any age. Causes of this disease are not known.
Your doctor will conduct a series of tests to diagnose your digestive problems. You will discuss options for treatment. POEM is an excellent treatment option for some patients, but not all. Talking to your doctor about the right option for you is best.
How is the POEM Procedure Performed?
POEM is a minimally invasive procedure that is done in an operating room. You are put to sleep under general anesthesia.
While you are asleep, your doctor will insert a thin, flexible tube down into your throat. Then an incision is made and a tunnel created between the layers of the esophagus in order to reach the lower esophageal muscle that is tight. Once the tunnel is created, your doctor will create an incision (called myotomy) on the lower muscle. This is a permanent cut. It creates an opening for liquids and foods to pass freely.
How Long Does the POEM Procedure Take?
The procedure takes around an hour and a half to complete.
What are Benefits of POEM Procedure?
The main benefit from POEM is a faster recovery time. This procedure has no cuts or scars on the outside of the body. POEM is also safer for the following patients:
- Have had previous upper abdominal surgeries
- Have heart, lung or kidney problems
- Are morbidly obese
You can return to an active lifestyle faster with this less invasive method.
Learn from one patient's POEM procedure at IU Health and how the procedure helped in their treatment journey.
Your doctor will admit you for an overnight stay in the hospital. This is to monitor you closely after the procedure. Following the procedure, your doctor will order an X-ray on your esophagus (esophagram) to make sure the surgical area is intact before you are given anything to drink. Once this is read by a radiologist, you will start on a full liquid diet.
You will be given hydration by IV and antibiotics before and after the procedure until you are allowed to go home. Pain medication is sometimes needed but most patients have no pain the next day. Your diet will progress to a soft diet after the first three days and then you will speak to one of our triage nurses on the phone to see how you are doing.
If you are doing well, you can start on a regular diet at this time.
What Happens When I Go Home? Can I Go Back to Work?
You will be discharged from the hospital the day after your procedure as long as there are no complications. When you go home, you will be given a diet to follow for the next month. Every patient is different, so how you do will determine your diet progress.
Our nurses will call you at multiple intervals. They will:
- Check on your progress
- Answer your questions
- Give you support and suggestions on healing properly
You will resume all home medications when you go home unless otherwise instructed by your doctor at this time. Along with your home medications will be a course of antibiotics to finish for the next seven days to prevent infection. After the procedure, you will be on a two week course of medication to reduce acid in your stomach while you heal.
All patients are given a lifting restriction of no more than 15 pounds for the first two weeks. You can return to work on light duty the day after your discharge.
Will I Ever Be Able to Eat Normally Again?
Yes. Diet instructions will be given to you on the day of discharge but also reviewed with you at your initial visit. The first three days after your procedure you will be on a full liquid diet.
After that, you will progress to a soft diet. Once our nurses call you to check your progress, a regular diet will be allowed with minor restrictions. Most patients report they are once again able to eat a normal diet.
Will I Have to Come Back for More Testing?
Yes. POEM patients come back for testing at 6 months, 2 years and 5 years after the procedure. We’ll do a series of tests at these appointments, including an upper endoscopy. It is important to follow up with testing as sometimes symptoms return or do not go totally away. Your doctor will discuss results with you after completion.
After Your POEM Procedure
Your doctor will admit you for an overnight stay in the hospital. This is to monitor you closely after the procedure. Following the procedure, your doctor will order an X-ray on your esophagus (esophagram) to make sure the surgical area is intact before you are given anything to drink. Once this is read by a radiologist, you will start on a full liquid diet.
You will be given hydration by IV and antibiotics before and after the procedure until you are allowed to go home. Pain medication is sometimes needed but most patients have no pain the next day. Your diet will progress to a soft diet after the first three days and then you will speak to one of our triage nurses on the phone to see how you are doing.
If you are doing well, you can start on a regular diet at this time.
What Happens When I Go Home? Can I Go Back to Work?
You will be discharged from the hospital the day after your procedure as long as there are no complications. When you go home, you will be given a diet to follow for the next month. Every patient is different, so how you do will determine your diet progress.
Our nurses will call you at multiple intervals. They will:
- Check on your progress
- Answer your questions
- Give you support and suggestions on healing properly
You will resume all home medications when you go home unless otherwise instructed by your doctor at this time. Along with your home medications will be a course of antibiotics to finish for the next seven days to prevent infection. After the procedure, you will be on a two week course of medication to reduce acid in your stomach while you heal.
All patients are given a lifting restriction of no more than 15 pounds for the first two weeks. You can return to work on light duty the day after your discharge.
Will I Ever Be Able to Eat Normally Again?
Yes. Diet instructions will be given to you on the day of discharge but also reviewed with you at your initial visit. The first three days after your procedure you will be on a full liquid diet.
After that, you will progress to a soft diet. Once our nurses call you to check your progress, a regular diet will be allowed with minor restrictions. Most patients report they are once again able to eat a normal diet.
Will I Have to Come Back for More Testing?
Yes. POEM patients come back for testing at 6 months, 2 years and 5 years after the procedure. We’ll do a series of tests at these appointments, including an upper endoscopy. It is important to follow up with testing as sometimes symptoms return or do not go totally away. Your doctor will discuss results with you after completion.
