Peroral Endoscopic Myotomy (POEM)

What is a Peroral Endoscopic Myotomy (POEM)?

The Peroral Endoscopic Myotomy (POEM) procedure is designed to address specific motility disorders, like achalasia, a conditioned marked by excessive tightness in the sphincter muscle between the esophagus and the stomach, causing the surrounding esophageal muscles to struggle to move swallowed food down, hindering its passage into the stomach. This can lead to symptoms like coughing or choking, sore throat, food becoming lodged in the esophagus, and weight loss and nutrient deficiencies.

Because this procedure requires specialized training that very few gastroenterologists possess, it is performed by Dr. Perry, our advanced endoscopic interventionalist, by cutting muscle fibers that fail to relax properly, thus facilitating the movement of food or liquid through the digestive system. Aside from achalasia, the POEM technique is particularly effective in treating swallowing difficulties caused by muscle problems, such as esophageal spasms, that do not respond to medicinal intervention.

What to expect during a POEM procedure

The POEM procedure typically lasts about one hour and is conducted under general anesthesia. It is minimally invasive, resulting in no visible scars. After the procedure, the care team will monitor your recovery as the sedative wears off. POEM can be performed as an outpatient procedure, or it may necessitate an overnight hospital stay. POEM involves the use of an endoscope—a slender, flexible tube equipped with a camera—inserted through the mouth (peroral) to cut muscles in the esophagus, a process known as myotomy.

The procedure includes four main steps:

Mucosal Incision: Your doctor makes a small opening in the inner lining of your digestive tract.

Submucosal Tunneling: A tunnel is formed beneath the lining, creating a space for the procedure.

Myotomy: Tight muscle fibers are carefully cut to promote better relaxation and opening.

Closure: The initial opening is secured with clips.

Since the entire procedure is performed through the mouth, no external incisions are made on your skin. Carbon dioxide gas is utilized during the procedure to assist in creating the necessary working space.

Additional POEM Procedures

Click below to learn more about other POEM procedures performed by Dr. Perry.

Gastric Peroral Endoscopic Myotomy (G-POEM)

What is Gastric Peroral Endoscopic Myotomy (G-POEM)?

G-POEM (Gastric Peroral Endoscopic Myotomy) is a minimally invasive, incision-free endoscopic procedure designed to treat severe, medically refractory gastroparesis.

This chronic condition occurs when the stomach muscles are weak or paralyzed, leading to food remaining in the stomach for extended periods. The procedure involves cutting the pylorus muscle, a ring-shaped smooth muscle that connects the stomach to the duodenum (the first section of the small intestine).

By doing so, it facilitates the stomach’s ability to empty food into the small intestine, alleviating symptoms such as chronic vomiting, nausea, and bloating. Gastroparesis can be caused by various factors, including diabetes, surgical interventions, or unknown origins. Patients who have not experienced relief from traditional dietary changes or medications may find significant benefits from this procedure, which is performed by an advanced interventional gastroenterologist.

What to expect during a G-POEM procedure

The patient is placed under general anesthesia, and an endoscope is introduced through the mouth, descending the esophagus and into the stomach. The gastroenterologist injects a liquid solution into the stomach to lift the lining of the stomach, to reach the submucosal layer.

A tunnel is formed in the submucosa, a layer of tissue under a membrane, progressing toward the pylorus (muscle), with an endoscopic knife. Upon reaching the lining, this knife is used to sever the muscle. This pivotal therapeutic step, known as pyloromyotomy, is designed to relax the pyloric sphincter to help alleviate gastroparesis.

After confirming that the muscle has been completely cut, the initial entry incision in the stomach lining is secured using endoscopic clips or sutures. The entire procedure generally lasts about 60 minutes, with patients typically discharged from the hospital same day or a brief overnight stay.

Zenker's Peroral Endoscopic Myotomy (Z-POEM)

What is Zenker's Peroral Endoscopic Myotomy (Z-POEM)?

Z-POEM (Zenker's Peroral Endoscopic Myotomy) is a minimally invasive procedure that requires no incisions and is designed to treat Zenker's diverticulum, a condition where an abnormal pouch is formed in the esophagus. This technique alleviates symptoms by tunneling beneath the esophageal lining to sever the muscle responsible for food blockages, significantly improving swallowing ability and reducing regurgitation.