Achalasia Treatment

How does per-oral endoscopic myotomy (POEM) work for Achalasia Treatment?

Achalasia is a rare condition where the lower esophageal sphincter (LES) fails to relax during food swallowing. As a result, food and liquids get stuck in the esophagus and patients report difficulty swallowing and food regurgitation. Achalasia patient may initially present with heartburn symptoms. Acid is trapped above the non-relaxing LES mimicking acid reflux. The traditional surgical treatment for achalasia is Heller Myotomy. Myotomy is a Latin word that means cutting a muscle. During a Heller myotomy, the LES muscle is cut open to alleviate the narrowing and allow normal swallowing. A partial fundoplication is then constructed; the gastric fundus is partially wrapped around the LES to prevent acid reflux without hampering swallowing.

POEM is a very interesting novel procedure for treating achalasia. Dr. Haruhiro Inoue, from Showa University, Northern Yokohama Hospital in Japan, has been developing this procedure since 2008. He has performed 900 cases so far with an excellent success rate. In a recent study, 370 patients followed for one to two years after POEM, showed improvement in symptoms with an overall success rate of 91%. A downside of POEM therapy is the inability to construct a barrier against acid reflux. Indeed, one in five patients complains of heartburn or regurgitation after POEM procedure. A key to a successful POEM procedure is complete dissection of circular muscle at the level of the lower esophageal sphincter, LES. By weakening the LES to treat achalasia, patients are put at risk for acid reflux and food regurgitation. During Heller myotomy surgery, after cutting open the LES, a partial fundoplication is constructed to prevent acid reflux. For this reason, patients undergoing POEM need to be followed closely for acid reflux symptoms. At Houston Heartburn and Reflux Center, we recommend yearly upper endoscopy for the first 3 years after POEM.