A New Approach in the Treatment of Achalasia

March 13, 2015 Brian E. Louie, MD


One of the most rewarding aspects of surgery is that there is constant innovation to improve the operations we do to help patients. Last July, we introduced a new innovative procedure at Swedish called per oral endoscopic myotomy or POEM

The POEM procedure is used primarily to treat patients with achalasia. Achalasia is a disorder of the esophagus where the nerve fibers deteriorate leaving the esophagus without its propulsive power and the sphincter at the end of the esophagus that prevents reflux to remain closed.

Patients who develop achalasia usually begin to have trouble swallowing. It may start with food sticking and patients having to drink more water to allow food to pass into the stomach. Over time, patients will have trouble with even liquids passing.

All of the treatments for achalasia are directed at the sphincter muscle to allow it to relax or open so that the patient has an easier time eating and drinking. The most common treatment in North America is a myotomy or cutting the muscle the makes up the sphincter. Until recently, the only way to accomplish that was a surgery that was performed laparoscopically using five small incisions. 

With POEM, the myotomy can now be performed without any visible incisions on the patients abdomen. Using an endoscope placed inside the esophagus, a small cut is made in the inner lining of the esophagus. The endoscope is advanced between the layers of the esophagus till it reaches the sphincter. Small surgical instruments are then passed through the scope and the muscle cut to relieve the pressure.

Since July, Drs. Aye, Schembre and I have completed 14 POEM procedures with multiple POEMS booked for March. Patients have told us that they have returned to work within five days whereas the laparoscopic myotomy took closer to 10 days. They have experienced virtually no pain and eating has gotten significantly better. 

To me, this is the benefit of innovation. In past eras, this operation was done through the left chest, then through a large abdominal incision. For over 15 years, it has been done laparoscopically with five small incisions and now without any visible incisions. The results appear as good as before and maybe even better. Most importantly, patients are seeing the additional benefits of reducing time to recovery and less pain.

The techniques learned through the POEM procedure have many potential other applications including removal of small tumors and cancers. Expect more innovation to come!

Learn more about POEM


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