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POEM Procedure

Patients with swallowing disorders such as achalasia now have an endoscopic alternative to surgery. Peroral endoscopic myotomy — or POEM — can restore their ability to eat and drink without pain or regurgitation, with no visible scars.

The UCI Health Digestive Health Institute (DHI) is the only center in Orange County and one of only a handful on the West Coast with expertise in performing the POEM procedure. It can be used to treat achalasia types I, II and III.

Prior to POEM, standard treatment options for the debilitating swallowing condition included:

  • Surgical laparoscopic myotomy, with or without fundoplication
  • Pneumatic balloon dilation
  • Botox® injections

Patients who undergo the POEM procedure experience a dramatic reduction in dysphagia, or difficulty swallowing, as well as long-term relief from chest pain, regurgitation and the weight loss that usually accompanies the inability to eat or drink comfortably.

How POEM works

Once the patient has been prepped with an IV to provide fluids, antibiotics and anesthesia, our esophageal specialist inserts an endoscope — a narrow, flexible tube equipped with a light, camera and cutting tool — through the mouth and into the esophagus.

The physician makes a small cut in the lining of the esophagus, then threads the endoscope into the wall of the esophagus, creating a tunnel that separates and exposes the deep muscle from a superficial mucosal layer. After creating the tunnel, the physician then cuts the muscle along the lower esophageal sphincter to the top of the stomach. The cut in the esophageal lining is then closed with either endoscopic sutures or clips.

POEM patients usually stay in the hospital one or two days for observation and antibiotics to prevent infection. On the morning after the procedure, patients are given a barium X-ray to make sure there is no leakage. Patient are then given liquids to drink. If liquids are well tolerated, patients are allowed to go home, where they continue to advance their diet to include soft and solid food.

The POEM procedure doesn't correct any distention to the esophagus or restore peristalsis — the contraction and relaxation of esophageal muscles that move food and liquid from the throat to the stomach. But patients are able to resume eating and are free from chest pain, aside from occasional bouts of acid reflux, which usually can be controlled by acid-blocking medication.

For more information about the POEM procedure, contact our esophageal disease specialists at 888-717-4463 or complete our online appointment request form ›

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