POEM or Heller Myotomy? What are the pros and cons?

I live in Rhode Island, USA, I am 29 and I also have type 2 achalasia. I am at the point where I need to choose between the Heller procedure or the POEM. I see the benefits of both and was told I was the perfect canidate for either procedure. The tricky part is potentially setting myself up with life long heartburn, I would just be replacing one issue with another, and I am concerned with future issues with the POEM because it is so new (How will I be when Im 60, ya know?). I will be having my procedure in Boston, MA. as soon as I can make this choice.

I am currently squeezing a 10mg Niphedipine tablet under my tongue 30 mins before each meal up to three times a day just to eat, so the choice needs to be made soon before I build up a tolerance for the drug.

How do you feel now that u did it? Any spasms? I saw that u mentioned u felt like maybe u should have tried the POEM due to the soreness u feel now. I am so torn and I thought I would do the POEM to save on scarring and recovery time, knowing I can always go back and to the dor fundop. later if needed.

I wish I knew what caused this. I had part of my thyroid removed in 2009 and have had the spasms ever since. I was told the procedures may not stop my spasms and those are worse than barfing up everything I eat and drink. Feels like a crippling heart attack...yuck.

I thought I would be having kids by now in life, but instead I am struggling to stay above 100 pounds and being forced to choose between a new less invasive procedure that doesnt have much long term info, or a sure fire way to feel better but ill have the scars to remind me of how Im suffering.

I am sincerely glad that u are on ur way to normalcy. I know this choice is mine alone in the end, but if u or anyone out there has any insight in what I should do or how I can make a good choice here, dont be shy help a sister out.

All my best,

ChokingVictim

P.s. eat a cheeseburger for me....mmm

      I had POEM surgery around June 2013 and its been more than 2 and half years. The surgery was done well and I am sure i could say that my swallowing was so much better after the surgery. I have gained a lot of weight since my lowest. But I have put on fat on my stomach as well and I feel that will impact the swallowing function for achalasia. Even now I can swallow food. But I feel the swallowing functionc an be improved well if certain things are followed. But I would definitely recommend you speaking with the doctors which is best for you.

Here I give you some tips and advices. Any queries, feel free to ask.

Make sure you exercise regularly. Have an active life now and then. Why I say this is that, when you exercise well your appetite will improve and I have experience that your swallowing would function more better when you have good appetite to eat. make sure you split your meals well. 5 meals a day with a gap of 3 hours in between will be fine. You can have smaller quantity every meal. 

And don't do anything while eating. Like watching tv or doing something while eating. Don't have any conversations while eating either. Instead focus on what you eat. Relish every bite you take. Chew well and swallow well before taking another bite. What most achalasia people tend to do is they try to take the food and just push it down by taking another bite. Don't do that. Instead have your consious on eating alone and chew your food, relish it and swallow well. Seperate yourself so you can focus on what you eat.

Make sure you eat more calories than you burn a day. Don't try to eat heavily when you have appetite. When you feel you had sufficient amount of food that would be well enough. Instead of going on and eating because you love the food. Try to avoid that. 

Make sure you have a calm life. Just be calm and be active. Love yourself. Everyone is unique in their own way. Make sure you love every bit of yourself well. 

Good luck Sonia! 

  I had a Heller Myotomy with a Dor Fundoplication about seven years ago. That is when they found out I was already in end stage Achalasia. I was 54 at the time. I was very happy with the outcome, other than having more reflux, but still no aspiration. I have never had spasms as far as I know so I may not speak of them.

   In Sept. 2015 I had POEM Surgery recommended by my Doctor who did the original operation and he said it would resolve my swallowing problems, which had started up again.

   I wished I had never had the POEM Surgery. Food sticks worse than ever, I have terrible reflux and now I am aspirating it into my lungs when I sleep at night. I have had one dilation since the POEM Surgery which did not help with the swallowing and crreated more reflux. I believe these operations to be a balancing act of opening the LES enough to swallow, but not so much as to allow to much reflux to go through the other way. I would go with the Heller Myotomy and Dor Fundo. I also had a pyloromyotomy to help my stomach pass food through to my small intestine at a daster rate, because I had several blockages and was hospitalized the last time with a blockage that took four days to correct. The Pyloromyotomy has worked correctly.

                                                                    Schmundt

My GI doc recommends the Heller as a tried and true method that has good outcomes with the Kaiser team. He also thinks the fundo is necessary to lower the chances of GERD although he did say thay many patients develop GERD anyway. He thinks that the the surgeons' experience is the most improtant factor in some ways. Stanford says I can't get in for a consultation unless I have a doctor refer me in and send my records, and I can't wait until open enrollment in January to switch insurances. I'm trying to decide if I should pay for a POEM consult at Stanford or Winthrop in NY where they've done the most in the U.S. or just do the Heller in part to stop stressing and worrying about it.

I know there's no right answer and every experience is different but if anyone who has had either surgery can offer further insights about their experience and/or outcomes, I appreciate it. I do have spasms at night if my stomach is empty but not otherwise. 

I would also love to talk to someone who has gone through this so if anyone is local and would like to meet up, please let me know.

Thanks!