Heller or POEM?
Posted , 4 users are following.
I am 32, I have had typical achalasia symptoms forever but just got diagnosed a few months ago. I think I must be somewhat early-stage, as regurgitations are somewhat rare (~1x per week), fake heart attacks are rarer (~1x per month), and I generally haven't faced too many diet restrictions. I've had 3 minor dilations done with minimal risk of perforation (first one done over a decade ago), and those haven't helped tremendously.
I'm near Chicago and am working on getting insurance to approve a referral to Northwestern where they claim they specialize in achalasia. I'm trying to get in with a doctor specializing in POEM, but I'd like to hear your thoughts, because both the Heller and POEM are not reversible and I am not sure I want to do something so drastic. So here are my questions:
1. It seems that POEM is only preferred because it is less invasive and has a quicker recovery time. I've seen studies citing similar fail rates, similar reduction in achalasia symptoms, and similar or somewhat higher reports of acid reflux afterwards. Is there any other benefit to POEM you see?
2. Apparently the fundoplication is to prevent acid reflux. Why would I want to get the POEM procedure if it doesn't have something similar to prevent reflux?
3. Do you recommend that I go straight to the Heller or POEM procedures or would you try balloon dilation/botox first? I've heard that botox can make it more difficult to have the myotomy later on, not sure about dilation.
Thank you for any help you have to offer. I truly sympathize with those of you on here and am glad I found this site. The constant anxiety and discomfort achalasia brings is no fun.
0 likes, 6 replies
graeme35202 spencer00501
Posted
Hi
With Australasia the normal peristalsis of the oesophagus is absent or very reduced and the gastro oesophageal valve does not relax to allow food to pass into the stomach. So the treatments available aim to improve the opening of the GO valve. Botox may do this but in both the POEM procedure and Hellers myotomy do this by effectively destroying the muscles that control the valve. This means that a procedure such as a multiplication is needed to make a new valve and prevent reflux, particularly when you lay down at night.
Both hellers and POEM achieve the same but the POEM has a quicker recovery and has shown to be more successful. Hellers does not always work first time round. I have had my Hellers done twice now and the surgeon has done as make change as he can to dissect the muscles. I can swallow ok-ish with plenty of fluids and I can eat pretty much everything I want. Thanks to the fundoplication I don't get any reflux. I would say I'm 80% better than before any surgery when life was utterly miserable. The only problem with the fundoplication is trapped gas which on occasion can be quite painful. Gas can only go one way!! I did have a dilation early on which did not work and my surgeon said the results were not too good. Botox does work but is temporary and sooner or later you will be back to square one. So to cure your achalasia its either a laparoscopic Hellers and fundoplication or POEM that at some later stage may well need a laparoscopic fundoplication. So my advice is have the hellers and fundoplication.....it can be done again and you could then also have a POEM if it doesn't quite work. A lot comes down to the skill and experience of your surgeon so choose one who has treated a lot of achalasia patients........... best of luck mate
spencer00501 graeme35202
Posted
Thanks graeme.
So POEM can only be done once, but one can get Heller multiple times and one can get both Heller and POEM done? If that's the case, then as long as I find someone who is experienced with the procedure, either one should be OK, right?
It does seem that the myotomy is the only real way to go if I want to treat it. Large dilation seems to have a risk of perforation that isn't justified since it is usually a temporary fix, and botox is also temporary and may make future myotomy more difficult.
graeme35202 spencer00501
Posted
neil32387 spencer00501
Posted
There are some really interesting youtube vids on POEM ops. The procedure involves slicing carefully into the Oesophageal wall and then working down it, seperating the wall from the muscle with gas, and cutting( although more like an energy zap) through the muscle wall at any distance along the O. So apart from being less invasive I think it is more suited to longer cuts, and not just around the LES. The vids are worth a watch! I have had A for 15 years and no treatment yet, and am considering both ops too. I totally get your concerns. There are plenty of threads on here about those who have pushed on untreated as I have. Problem with A is that it seems everyones condition is kind of unique, so no clean cut choices...
Keep up the research! And best of luck..
N
spencer00501 neil32387
Posted
Thanks, Neil. I have seen some of the youtube vids. A few of the videos are by the guy that I am planning to see at Northwestern, which gives me some confidence that I'm going to someone with plenty of experience.
Just wondering - what has caused you to delay treatment? I have a few positives I can think of:
1. Maybe something newer and better will come along in the next decade or so that is more effective
2. Waiting will give researchers more time to figure out if POEM has long-lasting effects, adverse or positive in nature
3. The risk of complications is non-zero, and I've seen people on here post about having esophagectomy after the myotomy because of complications or issues post-procedure. Not something I want to dive into if I don't have to.
Are there other reasons you think people push on untreated?
neil32387 spencer00501
Posted
I think folk that push on, find ways of getting / keeping the food down. My own symtpoms - swallowing/spasms/regure got bad really quickly and lasted a year or two before flattening out. I rarely get spasms or regurge now; but have to walk around mid meal or raise an arm (pull a face or two also
to swallow. I just soldier on. The risk is a distended oesophagus, and maybe a risk of irritation due to bad drainage. My O is large, but I think that also happened quickly early on, so difficult to judge. If the swallowing had stayed the same or got worse I would have had treatment. I am considering POEM at the mo- as a matter of dilligence really; rather than anything else. May consider HM too. With all surgical options acid then becomes a risk; but if you have had dialations, then maybe you can deal with that... I go in a few weeks for another endoscopy - see how things are from there... no simple answers ... on we go!
..
N.