Peroral Endoscopic Myotomy (POEM)

Peroral Endoscopic Myotomy (POEM)

POEM is a therapeutic endoscopic procedure performed in the endoscopy unit at our hospital. We use high-definition upper endoscopes to perform the procedure. POEM takes approximately two to three hours, and you are expected to stay in the hospital for an average of two days for monitoring and to receive intravenous antibiotics.

Stomach Problems | Dr Gaurav Muktesh

POEM: Why It’s Performed

We perform POEM to treat the following disease:

  • Achalasia
  • Spastic esophageal disorders not responding to medical therapies (e.g., diffuse esophageal spam, nutcracker esophagus)

 

POEM: What to Expect

Before your procedure, you will need to follow specific preparation instructions. We will discuss them with you in detail. Preparation instructions are as follows:

  • You may only have a liquid diet for two days prior to the procedure.
  • You may not eat or drink for 12 hours prior to your procedure. This ensures that your esophagus is clear of food products.
  • Tell us if you have any allergies.
  • We will instruct you regarding any prescription medication you take.

On the day of the procedure, arrive three hours before your POEM is scheduled to start. When you arrive, you will register and give your medical history.

What you need to do before POEM?

You will be given a prescription for an antibiotic to take before the POEM procedure. We may alter your medicines.

During POEM:

  1. We will insert an IV into your vein to administer fluids, anaesthesia and antibiotics.
  2. We will insert an arterial line to monitor your pressure during the procedure.
  3. We will pass the endoscope through your mouth and into the esophagus where the therapy will be applied.
  4. We observe the images on a nearby monitor.
  5. There won’t be any incisions or cuts outside your gastrointestinal tract.
  6. An initial incision will be made in the internal lining of the esophagus. This permits entry of the endoscope to within the wall of the esophagus, where the muscle will be exposed.
  7. The inner layer of the muscle near the lower esophageal sphincter will be cut (this is termed myotomy).
  8. At the conclusion of the procedure, the esophageal incision will be closed with standard endoscopic clips.

What happens after POEM?

After the POEM procedure, you will be observed in the hospital overnight. An esophagram (X-ray of the esophagus) will be obtained the next day. You will be asked to consume a liquid diet for about 1 week, then soft food, advancing to a regular diet as tolerated. You will be given an acid-reducing medicine to take for 1 month after the procedure. The results of the procedure will be communicated.