What Is the POEM Procedure? A Modern Solution for Achalasia
Verified By
KIMS-SUNSHINE
Specialist,
26 July, 2025
Achalasia is a muscle disorder where the muscles in the oesophagus or food pipe are too tight. Along with the muscles of the food pipe on top, the sphincter muscle below does not contract or relax- causing food to not enter the stomach as needed. This can cause chest pain, inability to swallow and regurgitation, all of which can lead to weight loss and a failure to thrive. Symptoms tend to get worse if not treated soon. The muscles are tight because of damaged nerves in the region. Surgical intervention is the only definite way that can help manage symptoms, but repeated procedures may be needed in a few extreme cases.
What Is The POEM Procedure For Achalasia?
The POEM procedure stands for Peroral Endoscopic Myotomy- which is a minimally invasive procedure that involves cutting the tight muscle fibres, causing them to loosen up afterwards. This can help the patient eat or swallow liquids and solids more easily than before. It is similar to another procedure called Heller’s Myotomy- the only difference is the latter is NOT minimally invasive and is a traditional, open method of surgery.
How Is POEM Surgery Performed For Achalasia?
The POEM procedure begins with using general anaesthesia so that you are in no pain. Then, it uses an endoscope – which is a long tube that is threaded into the oesophagus, that has a camera at the end. This helps the surgeon visualise the muscles that are affected and hence need to be cut. The endoscope is then lowered to the Lower Oesophageal Sphincter (LES). It also has a small scalpel or knife that can make swift, precise cuts in the LES. This causes the tight muscle fibres to loosen up. This is called ‘myotomy’, after which the incision in the lining of the food pipe is closed securely.
POEM Procedure Benefits For Achalasia Treatment
The main advantages are as follows
- It is minimally invasive and since the endoscope is threaded down the throat, there are no incisions or scar marks on the surface of the skin on the belly or chest.
- Healing is much faster and there are less risks associated with this procedure.
- The success rate of the procedure is pretty high- about 88-96% in most cases.
- POEM is effective for treatment of different kinds of achalasia and other muscle disorders of the oesophagus, motility disorders of the food pipe and gastroparesis respectively.
Conclusion
A barium X-ray is done after POEM procedure, to check if the muscles in the food pipe are loose and working normally. You will also need to stick to a liquid-only diet for the next few days. You can then switch to soft or mushy foods for the second week and then slowly transition to your normal diet. Some people report side effects like GERD, pneumonia, pleural effusion etc. but these are very rare and are much easier to manage than the achalasia itself. Getting POEM done is a great choice if all other alternatives like pneumatic dilation or the usage of botulinum toxin has failed.
