The evolution of the myotomy to POEM for the treatment of achalasia
Achalasia is a rare disease that affects the nerves that supply the esophagus which results in loss of the normal contractions of the esophageal muscles. Historically, achalasia has been treated by laparoscopic Hellers myotomy, pneumatic dilation, and botulinum toxin (Botox) injection. In the recent years, a new procedure, Peroral Endoscopic Myotomy (POEM) has been introduced, and offers faster recovery after the procedure, the ability to better tailor the procedure to the patient, and is potentially more effective in patients with advanced disease.
The POEM procedure
1. An endoscopy of the upper gastrointestinal tract will be performed to suction out any residual debris and to aid in determining the length of the required muscle layer incision (myotomy).
2. The esophagus is composed of two main components: the “skin” lining the inside (mucosa) and the muscle layers. After injection of a saline solution under the mucosa, a “submucosal tunnel” is created to allow the endoscope enter under the mucosa and gain access to the muscle.
2. The esophagus is composed of two main components: the “skin” lining the inside (mucosa) and the muscle layers. After injection of a saline solution under the mucosa, a “submucosal tunnel” is created to allow the endoscope enter under the mucosa and gain access to the muscle.
3. After the tunnel is completed, the circular muscle myotomy is performed.
4. After the myotomy is completed, an antibiotic solution is instilled into the tunnel and the entry site is closed with clips.
4. After the myotomy is completed, an antibiotic solution is instilled into the tunnel and the entry site is closed with clips.
A printable version of the POEM procedure can be downloaded here
Performance of the POEM procedure (for healthcare providers) can be viewed on Dr. Bechara's YouTube channel below