The traditional treatment of achalasia involved a surgical operation called Heller myotomy. Myotomy means “cutting the muscle” - the sphincter muscle is divided carefully to release the spasm. More recently, an endoscopic treatment called POEM (Per Oral Endoscopic Myotomy) has been used very successfully to treat achalasia – this is much less invasive that surgery.
Achalasia is a very rare swallowing disorder involving disordered contraction of the muscles of the oesophagus and the sphincter between the oesophagus and stomach. In patients with achalasia, the sphincter remains very tight, not allowing food to pass into the stomach. Common symptoms include difficulty swallowing or regurgitation of food, as well as weight loss.
Initial investigation may involve a routine upper endoscopy or barium (xray contrast) swallow test to assess for other disorders that may be more common. The diagnosis of achalasia requires a specialised test called high resolution oesophageal manometry.
POEM is an endoscopic (non-surgical) procedure which takes between 1-2 hours to perform and does not involve any incisions on your abdomen or chest. This ensures faster recovery time and return to normal activities.
POEM procedure is performed in the endoscopy unit under a general anaesthesic. The flexible scope is inserted and used to create a “tunnel” or new pathway in the oesophagus between the normal lining of the oesophagus. A special knife is then used to divide the tight muscles that are causing the swallowing problems. Once this is done, the opening of the tunnel is closed with endoscopic clips. Please refer to the video below.
Overnight admission is recommended for observation and a special barium x-ray test the following day prior to starting back on fluids. Your doctor will then advise on resumption of your diet.
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As with any interventional endoscopic procedure, there are small risks of complications, which will be discussed at length during your consultation.
The information provided here is for general educational purposes only. If you would like to know if a POEM procedure is appropriate for your situation, please contact Sydney Gastroenterology & Liver Group.
For appointments and enquiries, please phone 02 9480 6210
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