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POEM, Per-Oral Endoscopic Myotomy, a new treatment for achalasia with no incision.

Posted , 15 users are following.

robert60861
robert60861

For all of you out there suffering from achalasia there is now a new non invasive treatment called POEM (Per-Oral Endoscopic Myotomy). I have been suffering from achalasia for over ten years however after having this treatment in Feb 2014 I have been trouble free ever since.

3 likes, 27 replies

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  • AlanJM
    AlanJM robert60861

    Posted

    POEM was discussed a bit at the meeting in December, as reported on the OPA website under Oesophagus and Achalasia.   Some countries have gone further down the road with it (eg Japan, Germany).    As I understand it, POEM is a technique that cuts the muscles within the lining of the lower oesophageal sphincter to release the pressure holding the sphincter closed.   There is a significant learning curve for the surgeons for this new technique, but the important thing is to have a full and proper diagnosis at specialist Upper GI centre to establish the precise cause of the achalasia - otherwise it might be jumping the gun and applying the wrong solution to any one individual diagmosis.   The person who had experienced it (autumn 2013) also reported great success so it does appear that this technique is starting to be used.

    It is great news that you have been trouble-free after such a long period of problems and I am sure that everyone will be delighted for you and interested in this development.

     

    • robert60861
      robert60861 AlanJM

      Posted

      Yes, Iuckily I am living in Japan so was able to get the surgeon who developed this procedure to conduct mine. At the time of my procedure he/his team had done over 500 operations and the success rate is astonishing. He also travels abroad on a regular basis to conduct operations all over the place, including the UK. I did leave a link to this procudure in my initial post however this was removed by the moderator.

      If you have any questions I will do my best to answer them. 

    • AlanJM
      AlanJM robert60861

      Posted

      Thanks, Robert.   No, this site does not accept website addresses  without moderation.

      If you are interested in having an account of your experience uploadad as a patient story on the OPA website, please contact me direct.

      _____

      Patient Moderator Note: I have removed an e-mail address from this reply as it is the policy of patient.info to not publish these within the forums. If any user is interested in this removed information they should contact the author via the Private Messaging system requesting such. Thank you for your cooperation.

  • dorsetgirl
    dorsetgirl robert60861

    Posted

    Hiya could you explain a little more about this poem procedure, I am classed as a high risk for any surgery due to me having benign heart tumors, so possible this poem procedure could be right for me,
    • robert60861
      robert60861 dorsetgirl

      Posted

      This information has been taken direct from the website relating to POEM.

      POEM is an endoscopic therapy which completes conventional surgical procedure with no skin incision.

      1) First the esophagus including the gastro-esophageal junction is carefully observed by endoscope.

      2) Incision is made on the esophageal mucosa.

      3）Under the submucosa, the tunnel is created endoscopically towards stomach.

      4) The myotomy is conducted onto the muscle around the esophagus to release the tightness on the distal end of the esophagus.

      5) Opening on the esophageal mucosa is closed by endoscopic clips.

      Hopefully the image I have attached is clear enough. Achalasia sufferers typically have an enlarged esophagus like the image on the left. Post surgery it should look like the image on the right. 

      I was in hospital for about five days then roughly off work for two weeks recovering. Since then I have been fine. 

  • paddie46788
    paddie46788 robert60861

    Posted

    I too had POEM surgery. You can see the entire process on youtube. Just type in Poem Surgery. there are a few.  Not a lot of statistics as it is new and few hospitals performing it. (except the one that had performed over 500). My surgeon is in Ontario Canada and I was his 7th proceedure. Took exactly the amount of time he said (90 minutes) and i was eating in about a month. My symptoms were gone immediately (throwing up, belching, chest pain, having to sleep sitting up.) I am now eating as normal as before achalasia.  Took 2 years to be diagnosed. As for the writer that talked about depression. I was at wits end and did not know how I could continue. Then every thing changed with the right diagnoses and Poem.  GOOD LUCK, I have not read one bad report on the surgery. 
    • teresa09761
      teresa09761 paddie46788

      Posted

      Hi. I also live in Ontario and had my POEM done out of the country in February 2014. I was denied coverage of payment by OHIP because POEM was considered experimental in Ontario. When did you get your POEM done and was it part of a research trial?
    • Jackster50
      Jackster50 paddie46788

      Posted

      Hello:

      I was wondering who did your POEM surgery in Ontario? I have a 21 year old son who has been very sick for almost 2 years. He recently had fundoplication surgery and he was unfortunately one of the 5 percent it didn't work for. He continues to suffer from Gerd like symptoms, trouble swallowing, pain basically pain from gum to bum, diarrehea, and trouble breathing. We are at a loss as the doctors seem to be as well. In the meantime he keeps loosing weight. He has tried FODMAP AND Paleo diet but is still having trouble. Need some direction hoping for help. Wondering if we keep being patient with our system in Ontario or head over the border somewhere. Thanks in advance. 

  • ricky20551
    ricky20551 robert60861

    Posted

    I was very interested in this procedure. I wonder how available is it in England though?
    • AlanJM
      AlanJM ricky20551

      Posted

      I know that they had demonstrations of it at University College Hospital in London, and that a few patinets have had it done in England.
  • paddie46788
    paddie46788 robert60861

    Posted

    The results are the same as the Hellers Myotomy, it is just less invassive as it is done through the throat. If I were suffering and could not get POEM, i would take the Hellers. It became unbareable for me to get through a day. (night especially). 
  • ricky20551
    ricky20551 robert60861

    Posted

    I seem to be able to get through the day ok if I do the important thing, which is "flush the tube" rapidly, first thing every morning with a large mug of water. My main concern at the moment is has any damage been done to the sphincter lining at the bottom of the osophogus, as I'm suffering with almost permanent heartburn-like pain. I have been taking anti-acid medication & Gaviscon but only Paracetemol helps this for a few hours(advised against Ibuprofen, which relieved it but can cause stomach probs). My doc sent me for a scan which revealed nothing too serious except some nodules which are going to be investigated when I shortly go for an endoscopy. I'm not looking forward to that as I remember the first one I had when the achalasia was first diagnosed 25 years ago.
  • AlanJM
    AlanJM robert60861

    Posted

    Prolonged exposure to stomach acid can affect the cells of the oesophagus, and lead on to a condition called Barrett's Oesophagus, where the cells start to become more like stomach / intestine cells.   The good thing about this is that they may then protect you from the pain felt as 'heartburn';  the bad thing is that Barrett's Oesophagus carries a risk of adenocarcinoma.   The overall rate is 0.3 - 0.5% per patient year.  People with newly-developed Barrett's Oesophagus may have a risk of 11 - 25% of developing adenocarcinoma before they are 80, but the risk increases markedly if there is high grade dysplasia.   The only way of finding out about this is with an endoscopy and biopsy.   There are treatments that can deal with Barrett's before it progresses to cancer.

    So I know you won't look forward to an endoscopy - my advice would be to have a sedative - but it is important to have an examination to sort out any other underlying problems rather than waiting until they get worse.

    Repeated stretching / dilatation of the sphincter can make the lining fibrous and thereby less responsive to potential surgery.

    So all this adds up to an argument for trying to get a really good diagnosis by a specilaist centre, and getting things sorted out as comprehensively as possible as early as you can rather than delaying things.

  • ricky20551
    ricky20551 robert60861

    Posted

    Yes, I did know some of what you've said but thanks for the additional info, better to know as much as possible.
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