POEM: An Innovative Procedure for Swallowing Disorders

A minimally invasive procedure to treat swallowing disorders is available at Atlantic Health System. For patients who struggle with strictures and spasms, the procedure — per oral endoscopic myotomy, or POEM — provides effective and long-lasting relief from painful and bothersome symptoms.

“The POEM technique is a trailblazing endoscopic procedure and a significant step toward an era of endoscopic surgery,” says Matthew Grossman, MD, interventional endoscopist at Atlantic Health System. “It’s an innovative technique that provides effective relief for roughly 90% of patients.”

The POEM procedure

First performed in Japan more than 10 years ago, POEM is an endoscopic technique used to treat multiple conditions caused by spasms of the lower esophageal sphincter. The procedure is a less-invasive alternative to a Heller myotomy, which requires incisions in the abdomen to gain laparoscopic access to the affected area.

During the procedure, a long and flexible camera called an endoscope is passed down your esophagus. The endoscope tunnels through the mucosa, or lining, of the esophagus to the spasm location. Under powerful magnification provided by the endoscopic camera, the lower esophageal sphincter is carefully cut to widen the area that allows access to the stomach. The endoscope is removed, and the incision is closed using tiny sutures or clips. Patients typically spend one night in the hospital after having the procedure and return home the next day.

After the procedure, patients experience immediate improvement in their ability to swallow food. However, patients may have an increase in acid reflux, which is typically well-controlled with antacid medication.

A new standard of care

A New England Journal of Medicine review published in 2019 showed the POEM procedure to be as effective as more extensive surgical procedures for the relief of achalasia and other swallowing disorder symptoms. The first to perform the POEM technique in New Jersey, Dr. Grossman has completed more than 300 procedures since 2017 and his colleagues at Morristown Medical Center, among them Dr. Nnaemeka Anyadike, also perform the procedure with excellent outcomes.

The POEM procedure is the new standard of care for the treatment of swallowing disorders, including achalasia, a condition in which the esophagus muscles do not properly contract to move food down into the stomach. In addition to offering patients a less invasive option to a surgical myotomy, the POEM technique also provides surgeons with improved access to the body of the esophagus. This is especially helpful for the treatment of achalasia that involves spasms of the body of the esophagus in addition to spasms of the lower esophageal sphincter.

Previously, treatment for achalasia and other conditions that cause spasming of the lower esophageal sphincter included Botox injections, which provide only temporary relief of symptoms, or laparoscopic surgery to cut the lower esophageal sphincter by going through the upper abdomen.

Hope for swallowing disorders and symptom relief

While the POEM procedure most often is used to treat achalasia, which is an uncommon disease, the experts at Atlantic Health also use the technique to treat patients with other types of esophageal spasms, including distal esophageal spasm or Jackhammer esophagus. Additionally, the POEM procedure has been modified to help patients with gastroparesis, a condition that prevents the stomach from fully emptying. Known as G-POEM, a gastric POEM procedure cuts the muscle at the end of the stomach, called the pylorus, to aid in gastric emptying.

Patients with achalasia and other swallowing disorders may experience the following symptoms:

• Difficulty swallowing food
• Frequent vomiting
• Weight loss
• Malnutrition
• Chest pain
• Sore throat
• Coughing
• Choking
• Feeling that food is caught in the throat

“People with swallowing disorders can struggle with their health and daily living activities,” says Dr. Grossman. “The POEM procedure offers patients the relief they need, along with less pain and a faster recovery than a traditional myotomy.”