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

Hi Cory.

POEM pros:

Less invasive/shorter recovery

Can make a longer incision that goes higher in E if needed

Better outcomes with Type 3

Easier to re-do on other side if necessary

POEM Cons:

No long-term results/outcomes

Insurance often won't pay for it

May have more reflux withought fundo

May have to travel to find surgeon with adequate experience

HM Pros:

Gold-standard, long-term outcomes available

Can do fundo, which may lessen reflux

More available than POEM

Insurance will likely pay

HM Cons:

More invasive/longer recovery

More possibility for complication

Fundo can be too tight and restrict swallowing or cause other complications

There is no right answer. Your son can have good/bad results with either as every person reacts differently. The surgeon's experience with HM or POEM is probaly the most important factor. It is essentially the same myotomy.

For the record, I had POEM about a month and a half ago. I had a good experience although developed bronchitis after surgery probably due to leftover food in my E being pushed into my lungs during incubation. My swallowing is at least 90% improved and it is wonderfult to be able to swallow food without having to think about it or be in pain. I am on a pretty strong dose of PPIs for three months and then will go off them and have acid testing. I am experienceing lots of burping, flatulance and nausea, which hopefully will settle down on it's own or due to altering my diet.  I will sleep 25-40 degrees elevated for life. I had to pay for POEM since my insurance denied it and would only pay for HM. 

There are wonderful achalasia Facebook groups with lots of discussions on POEM and HM if you want more info.

Good luck; I hope your son has a successful srugery. 

Lisa

My 16 year old was diagnosed in March after have very sudden onset of Achalasia in January.  I was never told anything about "stages" but I will say that his symptoms were bad enough to do surgery right away. (Thank goodness we don't live in Canada and don't have Kaiser, evidentially) 

?We were told that only 2 hospitals in the USA did the POEM for children, one being in Washington, DC only 30 minutes from us.  We met with and really liked the Chief of Thorasic Surgery at Children's Hospital in DC.  He breifly talked us throught the differences in the myotomy and the POEM but really felt the POEM was the way to go.

?He had the POEM in April.  It was great for about 4 weeks, symptoms mostly gone.  Then the symptoms started to come back slowly and by July he was miserable and unable to eat. 

?We scheduled a balloon dialation two weeks ago.  NOTHING changed.  He is going back in in 2 days for another balloon dialation.

?I was told that there was a great deal of inflamation from the GERD but the primary problem was the tightening of the muscles. 

?Not sure if this helps you at all.  I'm hoping for more answers after Friday.  But thought I should reply since we are both dealing with teenage sons! 

Great info Lisa, thanks, he is supposed to have POEM on Friday at UW Hospital but insurance is playing games and they have not decided yet if they will approve it, we are very frustrated with that part of the process.  The Doctor is also frustrated since he said they want to do these cutting edge procedures yet their own insurance company does not want to pay for them.   Good luck to you and thanks for your reply.

Cory

So sorry to hear it is not working out for your son Melanie.  I would be interested to hear what you find out after Friday.  My son is supposed to have his POEM at University of WI Hospital on Friday but we still dont know as of Wed. night if insurance will cover it.  Did you have any insurance issues?  My son's doctor had never done it on a child so he referred us to a surgeon who has done about 20 of them, all on adults.  He claims that so far, they have had very good success.  The GERD is something we worry about and dont want to have him on acid reducers all his life.  I truly hope they can figure out what is going on with your son. 

We were told that if the acid problem persisted, they could later go in and do the fundiplication, not sure if that is something you have looked at?

Stay in touch, prayers to your son.

Cory