Per-Oral Endoscopic Myotomy (POEM)

Per-Oral Endoscopic Myotomy (POEM) is a minimally invasive, endoscopic technique developed to treat achalasia. Achalasia occurs when the muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), fails to relax adequately. This results in difficulty swallowing (dysphagia) and can lead to the build up of food and liquids in the esophagus. Achalasia is a progressive disease and early management helps prevent complications from occurring later on. POEM uses an endoscope (a long, flexible tube) that is inserted into the mouth. Various instruments can be placed down the endoscope to facilitate different interventions.

An endoscope with the associated instrument is inserted into the mouth. The muscle is the deepest layer of the wall of the GI tract. A “tunnel” between the shallow layer of the GI tract (the “mucosa”) and the muscle will be created through a layer called the submucosa. This allows access to the site of the muscle, where a special endoscopic knife will be used to cut the muscle, thereby loosening it to help food and liquids move forward more easily.

You should drink liquids only for 48 hours before the procedure to ensure solid food is not sitting in your esophagus or stomach. You should have nothing by mouth at all for the 8 hours leading up to the procedure. If you are on blood thinning medications / anticoagulants (such as Plavix, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban etc.), please notify the office of the doctor who is performing your procedure. They will give you specific instructions on whether or not you should stop your blood thinner before the procedure.

Complications from POEM are uncommon. Some potential risks include bleeding, infection, side effects of the medications used to put you to sleep, or perforation. This is very rare but could result in the need for an emergency surgery. Very rarely, carbon dioxide used in the procedure can dissipate into the skin, around the lungs or abdominal cavity.

Will I have to stay in hospital?

You will be monitored in hospital overnight and will be discharged the following morning after a special X-Ray study is performed to ensure there is no leakage from around the area that was cut within the esophagus.

Will I have a scar?

Since POEM is performed through a tube that is inserted into the mouth, you will not have a scar on your skin.

Your doctor will instruct you on which medications to take

• Day 1: You will have nothing by mouth the day of your procedure.
• Day 2 and 3: You can have thin liquids and gellatins (eg: Jello, popsicles) the day following your procedure.
• Day 4-7: Advance diet to thick liquids (eg: soups, pudding, smoothies).
• Day 7: You can advance your diet to solids, as tolerated.

You may have ongoing discomfort with eating for upwards of 10 days after the procedure. You should continue to take your medications as prescribed

Return to the Emergency Room if you experience any of the following:

• Throwing up or vomiting blood
• Bloody or black, tarry bowel movements
• Severe abdominal pain or chest pain
• Intractable nausea or vomiting
• Fever > 38.5°C

You will have a phone call with your physician 1-2 weeks after the procedure