Per oral endoscopic myotomy (POEM) for achalasia

August 25, 2014 Brian E. Louie, MD

P.O.E.M. has come to Seattle at Swedish Medical Center. No, not the kind that rhymes but one that is elegant in its own way. Per Oral Endoscopic Myotomy or POEM is relatively new procedure used in the treatment of achalasia, which is a disorder of the esophagus due to degeneration of the nerve network within the walls of the esophagus. The diseases leaves patients with little propulsive power to push food toward and into the stomach as well as causing the “valve” at the top of the stomach to remain closed. This makes it difficult for patients to eat or drink. Patients may need to drink a lot of fluid to get food to pass into the stomach whereas others may feel pain or discomfort after eating and still others may have undigested food come up many hours after eating or when lying down.

The treatment for achalasia is to disrupt the valve to allow food and liquid pass more readily. This treatment has been accomplished by dilating or stretching the valve with a special balloon. More commonly, patients opt for laparoscopic surgery to cut the muscle of the valve. POEM now offers patients an incision-free option where the muscle is cut by introducing an endoscope through the mouth into the esophagus. POEM represents the first natural orifice surgical procedure.

Over the last 12 months, Dr. Aye and I underwent intensive training in the lab with several of the pioneering surgeons to learn the techniques used to perform POEM. We also created a team at Swedish to perform POEM and went through additional training with the team to perfect the technique. After careful planning and with the guidance of these surgeons, we successfully performed the first POEM procedure in Seattle on July 18, 2014. We followed this with two additional successful POEM procedures in August and expect to move forward with several more procedures in September. We are excited to be part of the growing number of centers to offering the POEM procedure for achalasia.

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