Poem Procedure (Per-Oral Endoscopic Myotomy) | Gastrology Hospital in Bangalore
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March, 2023

POEM Procedure (Per-Oral Endoscopic Myotomy)

Treatment for swallowing disorders caused by muscular issues, including esophageal spasms, involves a surgery called “peroral endoscopic myotomy” (POEM). POEM procedures use an endoscope which is a narrow flexible tube with a camera and it is inserted through the mouth (peroral) to cut muscles in the esophagus (a myotomy). Cutting the muscles allows food to pass easily to the stomach and prevents them from becoming tight and getting in the way of swallowing.

This procedure is performed using endoscopic techniques, so there is no need for an external incision. This is a minimally invasive option to Heller myotomy, a procedure that penetrates the esophagus through tiny incisions. Compared to conventional surgical treatments, endoscopic operations usually result in less discomfort and quicker recovery.

How POEM is performed?

  • The endoscopist places the flexible endoscope through the mouth into the esophagus while an individual is under general anesthesia. 
  • The innermost layer of the esophagus is cut in a minor way (the mucosa). The remaining portion of the esophagus's submucosa layer is then tunneled down with the endoscope. 
  • The endoscopist cuts the lower esophageal sphincter's muscle fibers in the lower esophagus. 
  • The treatment is finished by removing the endoscope and closing the first mucosal incision.

Who requires the POEM Procedure?

  • POEM is primarily employed to treat achalasia, a disorder in which the sphincter between the esophagus and the stomach becomes tight. Due to the inability of this muscle to rest and other esophageal muscles to assist in pushing food down, esophageal achalasia patients are not able to enable food to pass into the stomach. This may lead to weight loss, vitamin deficits, choking, coughing, hoarseness, and food stuck in the esophagus.
  • Patients for POEM procedures include people who suffer from symptoms of achalasia and have a poor quality of life. The surgery relieves achalasia by severing the muscles in the upper stomach, the sphincter, and the bottom part of the esophagus. This provides a larger passageway for food into the stomach.
  • Other disorders that induce esophageal spasms that do not respond to medication, including diffuse esophageal spasms and nutcracker or jackhammer, esophageal diseases, can also be managed with POEM.
  • Both children and adults can have POEM procedures; age is typically not a significant determinant. The procedure may be unsafe if there are underlying conditions including heart and lung problems. 
If you have these concerns, you can consult the best gastro surgeon in Bangalore and get a proper diagnosis before deciding to go for the POEM procedure. POEM can sometimes become complicated or less efficient if the patient has had a past esophageal operation.

What are the complications of POEM?

In general, POEM is a safe procedure. Bleeding or the possibility of a hole in the esophageal lining is quite rare. Complications are rare, but some of these are possible,
  • Infection
  • Gastroesophageal reflux disease 
  • Bleeding because of injury to the esophagus
  • Inflammation of esophagus
  • Collapsed lung
It is important to consult with the doctor if an individual suffers from the following symptoms:
  • Chest discomfort
  • Stomach problems
  • Shortness of breath
  • Bleeding in your stool
  • Black bowel movement 
  • Fever and cold
  • Vomiting

What does an individual do before POEM?

Most importantly, the preparation an individual must do before POEM is as follows:
  • Three days before the surgery, your doctor will advise you to stick to a liquid diet, and 24 hours before treatment, you need to take only clear liquids. 
  • A medication like an antibiotic will be given by the doctor to take prior to the POEM operation. 
It is, therefore, highly recommended that consultation with the doctor is a must before going ahead with the POEM procedure.

What exactly happens after POEM?

  • An individual will stay the night in the hospital under supervision following the POEM operation. 
  • The following day, an esophagram, and an X-ray of the esophagus will be obtained. The patient will be required to follow a liquid diet for about a week before going on to soft foods and eventually, a regular diet. 
  • After the procedure, one will be prescribed an acid-reducing medication to take for a month. 
The referring doctor lastly will inform the procedure's outcomes. This entire procedure of POEM is performed at Sakra World Hospital which is considered the best gastrology hospital in Bangalore. Our team of experts treats all kinds of gastroenterological problems and provides treatment plans based on your specific needs.



Dr Lorance Peter

Director - Gastroenterology & Hepatology

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