Peroral Endoscopic Myotomy (POEM) Procedure
POEM is an endoscopic procedure used to treat swallowing disorders, most commonly for Achalasia. The procedure uses endoscopic technology and it’s an inpatient procedure that normally takes between one to three hours to complete.
Swallowing disorders are usually caused by the esophagus muscles and the lower esophagus sphincter muscles not relaxing thus making it hard to swallow and hard for the food to pass into the stomach. Heartburn, weight loss, and overall low quality of life are among the symptoms besides swallowing issues.
One of the major benefits of having an endoscopic procedure especially for swallowing disorders is that there are no incisions in the chest or abdomen and minimal or sometimes no hospital post-procedure.
Since the endoscopes are flexible tubes that have a camera attached, they are passed through the mouth or rectum, thus allowing the physicians to see and examine the surfaces of the esophagus, stomach, intestines, and colon without making a large incision elsewhere on the body.
Pre-procedure
Before the procedure commences, the doctor will discuss the specific preparations that the patient needs to follow early enough. Additionally, the patient will be placed on a liquid diet for two days and will not be allowed to eat or drink anything for 12 hours before the actual procedure.
The patient will also discuss the medication he/she may be using prior to the procedure. This is because some medications may lead to complications like excess bleeding, hence the need to stop taking them. The doctor will advise on the medications to stop taking and to avoid altogether.
During the Procedure
During the procedure, which takes place in the operating theatre, the patient will first be administered with general anesthesia intravenously, which is combined with antibiotics. This will ensure the patient is completely asleep.
An endoscopic tube is then inserted into the patient’s mouth and down the esophagus. The endoscope usually has a small camera attached on the end of the tube which will enable the doctor to control where the endoscope tube goes by watching on a monitor next to him or her.
The endoscope tunnels into the lining of the esophagus muscles and makes a pathway. The endoscope tube is then linked to a special knife, which penetrates this new channel. The knife then removes or loosens the tight esophageal muscles that are causing difficulty swallowing. The lower esophageal sphincter and the upper section of the stomach are then severed.
Upon completion, endoscopic clips are inserted at the lining of the esophagus to keep the incision at the top closed, then the endoscope tube is removed upwards through the patient’s mouth.
Recovery After POEM Procedure
After the procedure, it is highly recommended that the patient stays in the hospital overnight for monitoring to make sure there are no complications. He/she may not eat anything immediately after the procedure.
The morning after the procedure, the patient will undergo a barium x-ray to ensure that the esophagus muscle is open and that there is no leakage. The patient will be started on a liquid diet and likely discharged on the same day.
A follow-up of seven to ten days is done whereby the patient and his/her surgeon will be meeting after the procedure on an outpatient basis for follow-up. He or she is then advised to return again around the three-month mark for a swallow study to make sure his/her esophagus empties well.
Possible Risk Factors of POEM Procedure
Just like any other procedure performed in a hospital setting, the POEM procedure may present some possible risks, which can be rare, but can be controlled.
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