Peroral Endoscopic Myotomy (POEM)

POEM is a therapeutic endoscopic procedure. In this method, procedure is conducted through high-definition upper endoscopes.

Indications

Helps in the treatment of following disease:

• Achalasia
• Spastic esophageal disorders resistant to conventional medical therapies (such as nutcracker esophagus, and diffuse esophageal spam).

Pre-operative instructions

Patient should be instructed to follow these things before undergoing POEM:

• Diet restricted to fluids only, 2 days prior to POEM
• Do not eat any liquids or foods for 12 hours before the procedure. It keeps the esophagus clear of food components.
• Inform the doctor about any allergies or history of allergic reaction

POEM Procedure

1. Placement of an IV into the vein to allow administration of antibiotics, anaesthesia and fluids.
2. Monitoring of pressure by an arterial line.
3. An endoscope is passed through the mouth that goes into the esophagus. The therapy starts once endoscope reaches the esophagus.
4. A clear image is seen at the monitor that provides assessment of GIT
5. Internal lining of the esophagus is incised. Once incised, an endoscope enters the esophagus to expose the muscles.
6. The inner muscles near the lower esophageal sphincter are sliced. This is called as myotomy.
7. The esophageal incision can undergo closure through standard endoscopic clips.

Post-operative instructions

Patient is required to stay at the hospital or clinic approximately for 2 days. It helps to monitor and examine the patient. Furthermore, intravenous antibiotics are given.