Peroral Endoscopic Myotomy (POEM): A Modern, Scar-Free Treatment for Achalasia

Peroral Endoscopic Myotomy (POEM) is an advanced, minimally invasive endoscopic procedure designed to treat achalasia, a condition in which the lower esophageal sphincter (LES) fails to relax properly. This prevents food and liquids from passing smoothly into the stomach, leading to difficulty swallowing, chest discomfort, and weight loss.

POEM offers a safe, effective, and incision-free solution that has transformed the management of achalasia worldwide.

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What Is Peroral Endoscopic Myotomy (POEM)?

POEM is performed using a flexible endoscope inserted through the mouth, eliminating the need for external cuts or stitches.

In achalasia, the LES becomes abnormally tight. The main goal of POEM is to weaken these tight muscles, allowing easy passage of food and liquids.

Alternative treatments for achalasia include:

•Pneumatic (balloon) dilation

•Heller myotomy (traditional surgery)

•Botulinum toxin (Botox®️) injection

However, POEM is increasingly preferred due to its minimally invasive nature and high success rate.

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How Is POEM Performed?

The procedure is done under general anesthesia. Key steps include:

1.A flexible endoscope is passed through the mouth into the esophagus.

2.A small incision is made in the inner lining of the esophagus (mucosa).

3.The endoscope is tunneled through the submucosal layer down to the lower esophagus.

4.The tight muscle fibers of the lower esophageal sphincter are precisely cut.

5.The initial mucosal incision is closed, completing a scar-free, internal operation.

The entire process typically takes 30–60 minutes.

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How to Prepare for a POEM Procedure

Your doctor will give specific instructions, which usually include:

•Diet modification:

•Full-liquid diet for 3 days before the procedure

•Clear liquids for the last 24 hours

•Medication:

•A preventive antibiotic will be prescribed to take before the procedure

These steps ensure the esophagus is clean and reduce the risk of infection.

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What to Expect After the Procedure

After POEM:

•You will stay in the hospital overnight for observation.

•An esophagram (X-ray of the esophagus) is performed the next day to check healing and ensure there is no leak.

•You will begin a liquid diet for 1 week, gradually moving to soft foods, and then to a regular diet as tolerated.

•An acid-reducing medication is usually prescribed for 1 month to prevent reflux.

Most patients experience rapid and significant relief from swallowing difficulty.

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What Are the Potential Risks?

POEM is generally considered very safe. Rare complications may include:

•Bleeding

•Esophageal perforation (a small puncture)

•Infection

•Fever, chills

•Chest or stomach pain

•Vomiting

•Black or bloody stool

•Shortness of breath

Patients should follow discharge instructions closely and contact their doctor immediately if any warning symptoms occur.

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Why POEM Is Transforming Care for Achalasia

POEM has become a preferred treatment because it offers:

•No external scars

•Minimal pain

•Fast recovery

•Precise and durable muscle cutting

•Excellent long-term outcomes

For patients with achalasia or severe swallowing difficulty, POEM provides a life-changing solution.b