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POEM (Peroral Endoscopic Myotomy)

Endoscopic Treatment for Achalasia

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is POEM (Peroral Endoscopic Myotomy)?

Endoscopic alternative to surgical Heller myotomy for esophageal motility disorders.

Steps: mucosotomy, submucosal tunnel creation, myotomy of circular and (optionally) longitudinal muscle, closure with clips.

Most commonly performed for achalasia (types I, II, III); also effective for distal esophageal spasm and jackhammer esophagus.

No skin incision; entirely endoscopic via natural orifice (NOTES principle).

Symptoms

Targeted symptoms: dysphagia (solids and liquids), regurgitation.
Chest pain, weight loss.
Aspiration, pneumonia recurrence.
Achalasia type III: chest pain prominent.
Failed pneumatic dilation or botulinum toxin.

Risk Factors

Indications: achalasia (all types), distal esophageal spasm, jackhammer esophagus.
Suitable for prior failed treatments.
Type III achalasia particularly benefits (longer myotomy possible).
Contraindications: severe coagulopathy, prior extensive esophageal surgery, large hiatal hernia.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent dysphagia despite medical therapy.
  • High-resolution manometry confirming achalasia.
  • Eckardt score >3 indicating significant symptoms.
  • Failed pneumatic dilation or Heller myotomy.
  • Patient preference for minimally invasive option.

Treatment Methods

01
Preoperative: barium swallow, EGD, high-resolution manometry, timed barium esophagram, Eckardt score.
02
General anesthesia with endotracheal intubation.
03
Submucosal injection (saline + indigo carmine) for tunnel.
04
Mucosal entry 12-15 cm above GEJ; tunnel down to 2-3 cm below GEJ.
05
Selective inner circular myotomy (most common); full-thickness in select cases.
06
Mucosal closure with through-the-scope clips or endoloop.
07
Postoperative: NPO 24h, contrast study to exclude leak, clear liquids day 1, advance diet over week.
08
Long-term PPI for high GERD rate (~50%); endoscopic surveillance for esophagitis.

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.