Peroral endoscopic myotomy (POEM) is an endoscopic and minimally invasive surgical procedure for achalasia. Let’s know what is achalasia, it is an unusual disorder that occurs due to the degeneration of ganglion cells of the myenteric plexus in the lower esophageal wall. It is noticeable by a loss of peristalsis in the lower part of the esophagus and failure of the lower esophageal sphincter (LES) to relax. Peroral endoscopic myotomy (POEM) is effective medical intervention that aims to treat achalasia. In patients with achalasia, the lower esophageal sphincter is too tight. It uses upper endoscopy rather than conventional surgery, which involves an incision in the skin. The goal of all treatment of achalasia is to weaken the lower esophageal sphincter.
Why POEM is performed?
The gastroenterology specialist in shaikpet performs POEM surgery in Hyderabad to treat the following disease like:
- Achalasia
- Spastic esophageal disorders that are not responding to medical therapies (e.g., diffuse esophageal spam, nutcracker esophagus)
Preparation for the POEM procedure
As part of the preparation before the procedure, you will need to follow certain preparation instructions. Preparation instructions are as follows:
- You need to have a liquid diet for two days prior to the procedure
- You are not allowed eat or drink for 12 hours prior to your procedure. This ensures that your esophagus is clear of food products.
- Discuss with the doctor at gastric hospital in Shaikpet if you have any allergies (Medicines).
- Follow the medicines as prescribed by the doctor.
- Provide the doctor with your previous medical history and health issues details.
What is the process of POEM?
- IV will be inserted into your vein in order to administer fluids, anesthesia and antibiotics.
- Arterial line also is inserted to monitor your pressure during the procedure.
- Endoscope will be passed through the mouth and into the esophagus where the therapy will be applied.
- Incisions or cuts are not made outside your gastrointestinal tract.
- An initial incision will be made in the internal lining of the esophagus. This allows the entry of the endoscope to within the wall of the esophagus, here the muscle will be exposed.
- The inner layer of the muscle near the lower esophageal sphincter will be cut (this is termed myotomy).
- At the conclusion of the procedure, the esophageal incision will be closed with standard endoscopic clips.
What kind of Post-operative care needed after the procedure?
- To confirm the absence of the leakage, a gastrografin swallow study with fluoroscopy will be done.
- On the day 2 of procedure soft diet is advised and will continue for 10–14 days before starting a regular diet
- Intravenous antibiotics should be stopped on day 3 and switched to oral antibiotics for a total of 7 days.
- Proton pump inhibitors should be prescribed for a minimum of 14 days.
How frequently Follow-up has to be done?
Follow up of 3-6 months is needed after the post-procedure should include EGD, manometry and a pH study to evaluate the patient’s outcome and to find any complications.
What are the potential complications of POEM?
POEM is generally a safe procedure, yet times rare complications is included. If you notice the following please must the visit the doctor
- Bleeding and a puncture (or perforation) in the lining of the esophagus.
- Blood in your stool, black stool
- Fever, chills
- Vomiting
- Chest pain, stomach pain, or shortness of breath
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