Peroral Endoscopic Myotomy (POEM) | University of Michigan Health (2024)

FAQs

What is a peroral endoscopic myotomy poem procedure? ›

Peroral endoscopic myotomy is a procedure to treat swallowing disorders caused by muscle problems such as spasms in the esophagus. POEM uses an endoscope — a narrow flexible tube with a camera — that is inserted through the mouth (peroral) to cut muscles in the esophagus (a myotomy).

Our initial experience with POEM suggests that patients experience mild–moderate pain that is usually managed with modest doses of opioids. Nonopioid analgesics appear to be a useful part of a multimodal pain management plan.

In their retrospective study, the authors found that Per-oral endoscopic myotomy (POEM) was associated with a clinical success rate of 88% at a mean duration of follow-up of 55 months. They also found a post-POEM Gastroesophageal Reflux rate of 33% as assessed by Esophagogastroduodenoscopy (EGD).

POEM is generally a safe procedure. Rare complications include bleeding and a puncture (or perforation) in the lining of the esophagus. If you notice blood in your stool, black stool, fever, chills, vomiting, chest pain, stomach pain, or shortness of breath, contact your doctor as instructed on your discharge papers.

While POEM is a safe procedure, it does come with certain risks. Fortunately, complications from POEM are rare but may include tears in the tissue lining the esophagus (the mucosa), bleeding, collapsed lung, and pneumomediastinum (air in the mediastinum, the space between the lungs).

Clear liquid diet

Starting the day after your procedure and continuing through Day 2, drink only liquids that you can see through. Liquids should be clear, caffeine-free, non-carbonated, and low-sugar or sugar-free.

You will be admitted to the hospital afterwards and most patients stay for less than one day. The morning after the procedure, you will undergo a barium X-ray to ensure that the esophagus muscle is open and that there is no leakage. You will be started on a liquid diet and likely discharged from the hospital that day.

For POEM patients without complications, the average cost ranges between Rs 1,50,000 to Rs. 2,00,000. What is g poem procedure in Hyderabad? Gastric peroral endoscopic myotomy is referred to as G-POEM.

POEM is performed under general anesthesia with endotracheal intubation using an orally inserted flexible fiberscope. The aim of this study is to describe the anesthetic management of POEM for achalasia.

The authors found a relapse rate of symptomatic achalasia in 9.8% of patients post-POEM defined by an Eckhardt score >3 and findings on either high-resolution manometry or barium esophagram consistent with persistent achalasia.

Which is better Heller myotomy or poem? ›

POEM has improved efficacy compared to PD with similar cost-effectiveness. POEM results showed comparable patient outcomes when compared with laparoscopic myotomy. Overall, POEM is a feasible first-line treatment for achalasia.

If it is untreated for a prolonged period of time, the esophagus may become enlarged and eventually stop working. Researchers have noted that patients with untreated achalasia have 16 times the chance of developing a form of cancer known as esophageal squamous cell carcinoma (ESCC).

There may be minor throat, chest, or abdominal pain after the procedure that can be expected but is usually easily controlled and lasts only a few days.

You may lift objects as tolerated. Most pain is due to the incisions and can be controlled often ibuprofen alone. However, narcotics will be given after surgery, and should be used as needed. Avoid taking narcotics on an empty stomach to help prevent nausea from occurring.

Late complications of myotomy include the development of a hernia at the site of an incision, a bowel obstruction or recurrence of the achalasia. The formation of a hernia and the later development of a bowel obstruction are both more common following an open myotomy than a laparoscopic one.

G-POEM is a minimally invasive procedure that is done in an operating room. You are put to sleep for this procedure with general anesthesia. This procedure takes around an hour and a half to complete.

POEM is performed in six key/critical steps: (1) diagnostic endoscopy; (2) taking measurements; (3) esophageal mucosotomy creation; (4) submucosal tunneling; (5) selective circular myotomy of the anterior lower esophageal sphincter; and (6) closure of the mucosotomy.

The first three days after your procedure you will be on a full liquid diet. After that, you will progress to a soft diet. Once our nurses call you to check your progress, a regular diet will be allowed with minor restrictions. Most patients report they are once again able to eat a normal diet.