The POEM procedure is a non-surgical intervention that is a less invasive alternative to surgical myotomy – a similar procedure to POEM that uses small incisions to reach the esophagus instead of accessing it orally. Endoscopic procedures are less painful and offer a faster recovery than open surgical procedures.
A multidisciplinary team is required to perform the POEM procedure. It includes:
- Gastroenterologists
- An ENT surgeon (otolaryngologist)
- An esophageal surgeon
- Specialized nurses
- Anesthesiologists
- Radiologists
- Nutrition experts
- Internists
- Swallowing, speech and language therapists
Zenker’s diverticulum is rare, occurring in less than 0.01% of the population. It is found more often in women than in men, usually in those who are 60 years old or above. It is caused by a spasm of the sphincter muscle in the upper esophagus.
Achalasia is similarly rare and is caused by a similar spasm of the sphincter muscle at the lower esophagus where it connects to the stomach.
Gastroparesis is a condition where the stomach empties very slowly. It is partly due to a weak stomach muscle and, in some cases, a spasm of the sphincter muscle at the end of the stomach where it connects to the small intestine (gastric pylorus).
In all three cases, the treatment is to release the muscle spasm by making an incision in the muscle ring.
Treatment
Using an endoscope – a narrow flexible tube with a camera – inserted through the mouth (peroral) to cut muscles in the esophagus (a myotomy), the POEM involves cutting the muscles to loosen them and prevent them from tightening and interfering with swallowing. For each condition, the treatment is similar (myotomy) but the muscle that is cut is different (upper esophagus – Zenker’s diverticulum, lower esophagus – achalasia, gastric pylorus – gastroparesis).
The procedure is approximately 90% effective in relieving esophageal spasms and, if treated appropriately, it is very unlikely for symptoms to recur. Results for gastroparesis are somewhat less effective (40-60% relief).
Causes
Zenker’s diverticulum develops when the muscle between the throat and esophagus (cricopharyngeus muscle) over-constricts, resulting in the throat above it to pouch out. As time progresses, the pouch can enlarge as the muscles below it excessively tighten.
For people with esophageal achalasia, the lower esophageal sphincter muscle does not relax, and other esophageal muscles do not help move swallowed food down, preventing it from entering the stomach.
For gastroparesis, it is a combination of a weakened stomach muscle (which “pushes” food out) and a spasm of the gastric pylorus.
Symptoms
- A feeling of having a lump in the throat
- A sensation of having excessive phlegm or mucus in the throat
- Bad breath
- Chronic cough
- Difficulty swallowing
- Regurgitation of food (often hours after a meal)
- Weight loss due to difficulty eating
