Peroral endoscopic myotomy (POEM) is a technique that involves tunneling between the muscle layers of the esophagus to treat achalasia, including achalasia related to Chagas disease. Achalasia prohibits or reduces the ability of the muscles that make up the lower esophageal sphincter (between the esophagus and stomach) to relax. This therapeutic procedure is done completely through endoscopic methods, and no exterior cuts are made.
During a POEM procedure, an endoscope is passed through the mouth, and upon reaching the esophagus, an incision is made through the esophageal wall down to the muscle. When the muscle is reached, the endoscopist creates a tunnel downward toward the junction between the esophagus and stomach, where certain muscles are divided in order to ease the entry of food and drink to the stomach from the esophagus.
Patients are required to fast for 12 hours before the procedure, making sure that the upper gastrointestinal tract, namely the esophagus, is clear of any food or food residue. Patients are admitted for the POEM procedure, which usually takes 2 to 3 hours. A barium contrast study is used after the procedure to determine if normal swallowing function has returned, and when successful, patients are able to return to restore normal eating after first following a clear liquid diet.
Quick recovery and high success rates mark some of the benefits of peroral endoscopic myotomy, which can see patients able to swallow normally sometimes within 24 to 48 hours.