Achalasia is a rare disorder of the esophagus (food pipe) that results in significant swallowing problems for patients. The esophagus is a ‘food pipe’ that connects the mouth to the stomach. The function of the esophagus is to contract and push down food from the mouth to the stomach. In achalasia, because the muscles in the lower esophagus does not relax properly when eating, patients can have the feeling of food getting ‘stuck’ in their chest. Achalasia can be diagnosed with a special test called manometry that measures the function of the muscles of the esophagus.
The most common symptoms of achalasia are:
The treatments for achalasia are aimed at weakening or reducing the pressure of the muscles at the bottom of the esophagus. The best treatment for achalasia is to cut the muscle of the lower esophagus to allow for adequate relaxation and passage of food. This has conventionally required a thoracic surgery to achieve – a procedure called a Heller Myotomy. During this surgery a thoracic surgeon dissects into the chest to the level of the esophagus and cuts the muscle of the lower esophagus. This is an invasive procedure that requires a significant recovery time for patients.
The POEM procedure is a novel technique that has revolutionized the treatment of achalasia. With modern technologic instruments endoscopists can now perform the same therapeutic maneuver (cutting of the muscle of the lower esophagus) completely from within the body using an endoscope. POEM has been shown to be as effective as surgery, safe, and with very short recovery times. Generally patients need to stay in the hospital only one night after a POEM procedure.
You will have specific instructions from your physician about what you need to do prior to the procedure. Generally the main preparation is to have a clean esophagus – devoid of solid food debris so that the working space is clean for the procedure. To achieve this, your endoscopist may ask for you to be on a liquid diet for 24-48 hours prior to the procedure.
All POEM procedures are performed under general anesthesia, thus the patient will not feel any pain or remember the procedure. Once the patient is sedated, the endoscopists will insert the endoscope into your mouth where it will travel down your esophagus to the area that requires the procedure. Using specialized instruments and precise maneuvers, the endoscope will dissect down to the muscle of the lower esophagus and cut that muscle. All incisions into the esophagus lining will be closed with clips or sutures. After the procedure, the patient will recover from anesthesia with no skin incisions as all of the intervention is from inside the body.
After the POEM procedure is complete, you will be taken into a recovery room until the sedation has worn off. At that time, your doctor will come in and discuss the procedure with you. This is when you will be admitted into the hospital for monitoring.
The next morning you will have a barium x-ray to assure that there is adequate passage of contents through the esophagus and no leakage from any of the incisions. If the x-ray is normal than the patient will be discharged and begin a slow progression of diet.
Are you interested in learning more about POEM, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.