Per-oral Endoscopic Myotomy (POEM)

A POEM is performed using a narrow, flexible tube called a Gastroscope, which has a camera in the tip that captures images of your upper gastrointestinal tract. These images are transmitted to a TV monitor, which your specialist looks at during the examination.

O-POEM (Oesophageal) An endoscopic technique used for cutting of the oesophageal muscles and lower oesophageal sphincter (LOS) to relax this and allow food to flow more easily out of the oesophagus.
G-POEM (Gastric) A similar technique used to cut the pyloric muscle (the valve between your stomach and small bowel) to relax this to allow food to flow more easily out of the stomach.

Why is a POEM performed?

To treat achalasia and swallowing disorders or gastroparesis
Cutting the overly tight and rigid oesophageal (O-POEM) or pyloric stomach (G-POEM) muscles may allow food to propel down more easily to relieve symptoms.

What is the preparation for a POEM?

Take your usual medications. You will receive instructions regarding blood thinners separately as these need to be stopped.
2 days before: Have liquid diet only: clear soups, jelly, ice cream, yoghurt. Drink one litre of Coca-Cola (diet, zero or regular). This helps to dissolve food sitting in the oesophagus or stomach (the oesophagus has to be completely clear to perform the procedure).
1 day before: Liquids only, and another one litre of Coca-Cola.

How is a POEM performed?

An electrical scalpel, 2mm is passed through the Gastroscope to make an incision (1.5cm long) in the lining of the tract. A tunnel is created within the wall of the oesophagus or stomach (between the inner lining of the tract and the outer muscle layer of the tract). The Gastroscope is advanced into that tunnel, and the muscle of the oesophagus (O-POEM) or pylorus (G-POEM) cut full thickness to relieve the pressure. The entrance to the tunnel is then closed with temporary metal clips, so no leakage of contents can occur.

The procedure generally takes 60-90 minutes, completed under full general anaesthetic (you will be completely asleep, with a machine assisting your breathing).

O-POEM

G-POEM

What happens after a POEM?

It is common to have some chest or abdominal discomfort post procedure, you will be administered pain relief for this. You will be admitted overnight to hospital for monitoring and symptom management. You will have nothing to eat or drink for 24 hours to allow the operation site to heal. After this period, you will be given some water as a trial to drink. If this is consumed without issue, you can be discharged home.

On discharge, you will be given a prescription for:

Omeprazole to reduce acid, allow wounds to heal and prevent reflux.
Antibiotics to prevent infection.
Pain relief to manage pain as needed.

You can resume normal activities as you wish one day after the procedure. Resume further activity as per your specialists instructions.

Eating and Drinking

It is important to begin planning how you will manage after you are discharged home. You will need to organise your meals for the first few days after your procedure, and shop accordingly.

To reduce discomfort and allow your stomach to heal, it is recommended you follow a modified diet. Please refer to appendix for examples:

Day 1: Clear oral fluids only.
Day2-3: Liquid diet.
Day 4-5: Liquid and pureed diet.
Day 6: Resume normal diet as tolerated.

It is also recommended that you:

Eat/drink slowly and chew food thoroughly.
Eat/drink small, frequent meals to avoid putting too much pressure on your stomach.
Eat/drink sitting upright, try not to lie flat after meals.

Oral care

It is important to maintain good oral hygiene practices for your oral health. This includes brushing teeth regularly and drinking water after a sugar sweetened drink.

Follow-up

Things can take some time to settle and improve. You will have a review with your specialist 6 weeks post procedure to assess symptoms.

What are the risks associated with a POEM?

POEM is minimally invasive and safe and serious complications are rare.

Bleeding: bleeding will be stopped with coagulation during the case. Rarely, late bleeding can happen for up to 2 weeks after the procedure and would require a prolonged hospital admission and treatment likely including blood transfusion.
Perforation: this is when a hole is made in the oesophagus or stomach wall and occurs <1% of the time. This may require a prolonged hospital stay or even surgery.
Infection: 5 days of antibiotic are prescribed to reduce this risk. This may include lung infections from aspiration (food coming back down the wrong tube) and mediastinitis (<1%) in which fever and pain occur and intravenous antibiotics are required.
Leak: at the entry point due to dislodged clips. This is the most serious complication. This is very rare and may require surgical assistance and a prolonged period of artificial feeding to allow for healing.
Reflux: in O-POEM may occur 10-30% of the time, with the vast majority treated with omeprazole (ant-acid medication). If persistent reflux occurs despite this, anti-reflux surgery can be performed.

If you have a fever, vomit more than half cup of fresh red blood or have persistent black stools please notify your specialist.

Book an appointment