POEM treatment for patients with impaired swallowing function

Peroral Endoscopic Myotomy (POEM) is known as an advanced endoscopic treatment method used in the treatment of diseases that cause swallowing difficulties. With this method, the problematic muscles in the esophagus are cut by entering through the mouth as if a normal endoscopy is performed. Previously, the treatment of these diseases was carried out either surgically or with the endoscopic balloon method.


Balloon or botox applications used in the treatment of swallowing difficulties could not offer a permanent solution because they required repeating every 3-6 months. 

The POEM method, on the other hand, aims to provide a definitive solution by using it in the treatment of diseases that cause swallowing difficulties such as achalasia and diseases that cause delayed gastric emptying. 

Achalasia disease, which has an important place among the diseases that cause difficulty in swallowing, is manifested by symptoms such as dysphagia after eating, a feeling of getting stuck and stuck in the chest, infections caused by food coming back from the mouth and escaping into the lungs, bad breath and chest pain. 

The POEM method is also often used in the treatment of achalasia. Patients suffering from this disorder often apply to the physician with difficulty in swallowing. Patients begin to feel difficulty swallowing solid foods. In the future, even swallowing liquid foods is difficult. 

A burning sensation in the chest, intermittent cough and bad breath are also among the symptoms. Endoscopic examination is performed in patients who apply with such complaints. 

If the endoscope is caught in the lower part of the esophagus while passing through, achalasia is suspected. If it is seen that the esophagus narrows like an hourglass, a definitive diagnosis is made. 

Pressures in the muscle layer of the esophagus are measured, and if the pressure in the lower esophagus is high, achalasia is diagnosed again. With the method called esophageal manometry, the working order of the esophagus and the contraction movements during swallowing are measured. 

Achalasia diagnosis is confirmed by manometric measurement in patients who present to the doctor with swallowing disorder, if no tumor is detected in the endoscopic evaluation, and if there is no sign of reflux.

Swallowing difficulties are treated without incisions and scars.

With the development of endoscopy, alacsia patients can be treated without any incision marks. By opening a tunnel through the wall of the esophagus, the muscle layer at the bottom of the esophagus is reached. 

The muscle fibers found here are cut and one goes up through the same hole. The hole opened in the esophagus is closed with small stitches. This procedure, which is performed under anesthesia, takes approximately 45-90 minutes. 

Patients do not feel pain during the procedure, they need to stay in the hospital for a day or two. A control film is taken the day after the surgery to see if there is any leakage. 

First, liquid and then solid food intake begins, it is checked again, and after it is determined that there is no leakage, the patient is discharged.

What are the advantages of the POEM method?

Since the complication rates are low, the POEM method is used in the primary treatment of achalasia in the world. This method offers patients a chance for permanent treatment. It improves the patient's quality of life. There is no incision scar after the operation. 

One or two days stay in the hospital. The number of sessions in the treatment is decreasing. It can also be used in different diseases. The use of the method other than swallowing difficulty also increases its value. 

For example, in the disease called "Gastroparesis", since the movements of the stomach are very limited, it takes a long time to empty the intestines. 

In these patients, the muscle tissue in the exit layer of the stomach is cut with the POEM method, and after the operation that lasts for 45-60 minutes, it is determined that the rate of emptying of the stomach increases.