Per-oral endoscopic myotomy (POEM)
What is a per-oral endoscopic myotomy (POEM)?
POEM is an advanced, minimally invasive endoscopic procedure used to treat achalasia, a serious motility disorder where the valve (sphincter) at the bottom of the oesophagus fails to relax, making it difficult for food and liquids to pass into the stomach.
Unlike traditional surgery, POEM is performed entirely through the mouth (per-oral) without external incisions. Dr Selvanderan uses an endoscope to create a tunnel beneath the inner lining of the oesophagus (submucosal tunnelling) and then carefully cuts the tight muscle fibres (myotomy) of the lower oesophageal sphincter.
Why might you need a POEM?
POEM is an effective, minimally invasive treatment for:
Achalasia: Patients diagnosed with Type I, II, or III achalasia who require long-term relief from difficulty swallowing (dysphagia).
Spastic oesophageal motility disorders: Certain other conditions such as jackhammer oesophagus involving non-relaxing or hypercontractile muscles of the oesophagus.
Preparing for your POEM
Dr Selvanderan’s rooms will provide detailed instructions regarding preparing for a POEM.
Fasting: You must fast for a minimum of 24 hours prior to the procedure, with a liquid diet for several days before that, to ensure the oesophagus is completely empty.
Medication: You will be advised on which medications (in particular blood-thinners) to stop
Pre-procedure assessment: You will have undergone comprehensive testing (manometry, gastroscopy, barium Swallow) as well as a thorough pre-procedure consultation with Dr Selvanderan
What to expect?
POEM is a complex, therapeutic procedure performed by Dr Selvanderan under general anaesthesia in an operating theatre setting. The procedure typically takes 60-90 minutes.
Anaesthesia: A specialist anaesthetist will administer a general anaesthetic and insert a breathing tube.
During the procedure: You will lie on your back. The endoscope is inserted. Dr Selvanderan performs a small incision in the lining of the oesophagus, creates a tunnel down to the lower sphincter, performs the muscle cut (myotomy), and then closes the initial incision with clips.
Recovery
POEM generally requires an overnight stay.
Post-procedure: You will remain in the hospital for 1-2 days for observation. A barium swallow X-ray is often performed the morning after to confirm the integrity of the repair before you start liquids.
Diet: You will start on a clear liquid diet, progressing slowly to a soft diet over 1 - 2 weeks. Dr Selvanderan will provide specific advice
Follow-up: Regular follow-up appointments with Dr Selvanderan will be scheduled.
Risks
POEM is a very safe procedure in experienced hands, but potential risks include:
Perforation: A tear in the full thickness of the oesophagus (rare due to the tunnelling technique).
Bleeding: Usually minimal, but can occur at the incision site.
Infection: Rare, but mediastinitis (infection in the chest) is a serious, albeit extremely rare, complication.
Reflux (GORD): Increased risk of developing new or worsened reflux symptoms due to the permanent muscle cut, which may require long-term medication.
Per-oral endoscopic myotomy with an expert
Dr Shane Selvanderan is one of the few Melbourne specialist gastroenterologists internationally trained and proficient in performing per-oral endoscopic myotomy (POEM). He introduced the procedure and established the POEM service at the Alfred Hospital. In the appropriate patient, POEM provides effective, incision-less treatment for achalasia and related oesophageal motility disorders.