Nonsurgical Achalasia Treatment With Poem

POEM Treatment: A Nonsurgical Method for Achalasia

Difficulty swallowing, or achalasia, can make eating and even drinking water a problem. You may feel as if the food or drink is stuck in your throat, and food may even come back into your mouth undigested. In such cases, POEM treatment, which stands out as an endoscopic treatment method, is also known as nonsurgical achalasia treatment.

You can find answers in our article to questions such as what POEM is, how it is performed, what the success rate of POEM is, and what the recovery process is like after POEM.

Daviva Health Group safely performs the POEM method without incisions in achalasia treatment with its expert team.

What Is POEM?

POEM (Peroral Endoscopic Myotomy) is an endoscopic treatment method used to treat esophageal disorders that cause difficulty swallowing, such as achalasia. In POEM treatment, no incision is made in the skin. In endoscopic methods, treatment is performed by reaching the esophagus through the mouth. It is more commonly known as nonsurgical achalasia treatment.

How Is POEM Performed?

• The POEM procedure is performed under general anesthesia.
• An endoscope with a camera at its tip is inserted through the mouth into the esophagus.
• Using special instruments, a small incision is made in the innermost layer of the esophagus, called the mucosa.
• Through this opening, a tunnel is created between the muscle layer and the inner layer by entering the esophagus.
• The nonrelaxing muscle fibers in the esophagus, which prevent swallowing, are cut along their length and relaxed.
• The endoscope is removed, and the initial incision made in the mucosa is closed with small clips or sutures.

For Which Conditions Is the POEM Method Used? Achalasia

It is a rare swallowing disorder that prevents swallowed food from reaching the stomach properly. In achalasia, the muscles in the esophagus do not work properly. The esophageal muscles may be weak, or they may not contract and relax in the correct order. Sometimes they may not work at all. The muscles at the lower end of the esophagus, just above the stomach, called the lower esophageal sphincter, usually do not open. Food and drink flow back into the esophagus.

• Difficulty swallowing (dysphagia)
• Regurgitation of food
• Chest pain
• Bitter fluid or undigested food coming back into the mouth
• Drooling
• Coughing fits are among the symptoms of achalasia.

The POEM method is used frequently, especially in achalasia. POEM (Peroral Endoscopic Myotomy) is known as nonsurgical achalasia treatment because it is most often performed in the treatment of achalasia.

Jackhammer Esophagus

It is a rare condition. It is an esophageal disorder characterized by spasms with extremely high pressure. It causes severe chest pain and difficulty swallowing.

Medication, dietary changes, and Botox treatment are used as the first treatment methods. However, in treatment-resistant Jackhammer Esophagus, the inner circular muscles of the esophagus and the muscles at its lower end can be cut with the POEM method and treated.

Diffuse Esophageal Spasm (DES)

It is a rare disorder that causes painful, uncoordinated, and simultaneous contractions of the esophagus.

Severe chest pain that can be mistaken for a heart attack and an inability to swallow food are among the symptoms of diffuse esophageal spasm.

Medication and lifestyle changes are first-line treatments. In cases where there is no response, the muscles causing the contractions can be cut with the POEM method and treated.

What Are the Advantages of the POEM Method?

• Because POEM treatment is an endoscopic procedure performed through the mouth, no incision is made in the skin. The absence of a skin incision means less pain. It also does not create a cosmetically concerning situation for patients.
• Scientific studies show that the POEM method provides a success rate of over 90%, especially in the treatment of achalasia. The fact that serious complications are seen in less than 1% of patients treated with the POEM method highlights the safety of the procedure.
• Because it is an endoscopic procedure, recovery is much faster than with surgical procedures. Patients stay in the hospital for less time and can return to social life much more quickly.

What Are the Risks of POEM (Peroral Endoscopic Myotomy)?

• Gastroesophageal reflux may occur after POEM treatment. Long-term acid-suppressing medication may be required.
• Although rare, damage to the esophageal mucosa may occur. If such a situation occurs, the damage is usually repaired immediately with clips during the procedure.
• Minor bleeding is common during POEM. However, significant bleeding is rare.
• Inflammation of tissue in the chest cavity is a very rare but serious complication.
• Postoperative chest pain is common. However, the pain is not a lasting condition.
• It is important that the POEM procedure be performed in fully equipped centers by physicians and teams specialized in this field.

Recovery After POEM

After POEM treatment, patients are usually kept under observation in a special area for a few hours. At this stage, it is normal for patients to feel some discomfort or pain in their throat or chest.

After the observation phase, patients are discharged after staying in the hospital for 1 to 2 days.

Light walking can be done. However, it is important to avoid heavy lifting or intense activities.

Nutrition is very important for 1 month after the POEM procedure. During this period, the dietary plan recommended by the doctor should be followed.

What Should Nutrition Be Like After POEM?

Nutrition is one of the most important issues to pay attention to after POEM treatment. In general, nutrition after POEM should be as follows. However, it should be remembered that every treatment is individualized. You should follow your doctor’s instructions during this process.

Post-POEM Nutrition Plan

• Days 1-2: Only liquid foods such as water, broth, apple juice, and tea
• Days 2-14: During this period, you can switch to puréed foods. Yogurt and puréed soups can be consumed.
• Weeks 2-4: You can switch to soft, easy-to-chew foods such as mashed potatoes and scrambled eggs.
• After 4 Weeks: You can gradually return to your normal diet according to your doctor’s advice.

Frequently Asked Questions About POEM

Is there a risk of recurrence after POEM?

After POEM, there is a low risk of symptom recurrence. This is usually due to incomplete initial cutting of the muscles or the body’s response during the healing process. Although POEM is a highly effective treatment, relapses can occur and additional endoscopic treatments may sometimes be necessary.

How long does the POEM procedure take?

The duration of POEM treatment may vary depending on the severity of the disease and the patient’s anatomical structure. However, in general, POEM takes 1 to 1.5 hours.

Can POEM be applied to all age groups?

Because POEM treatment is an endoscopic method, it can be applied to both children and older adults. It is especially a safer option for older patients who are considered at higher risk for surgery.

When can I return to work after the procedure?

Recovery time varies from patient to patient. Patients who work desk jobs can usually return to work after 2 weeks. However, this period is longer for those who work in physically demanding jobs. It is important to follow the dietary rules during this process.