POEM for Achalasia Cardia: Advanced Scarless Treatment for Swallowing Disorders

Understanding Achalasia Cardia and Swallowing Disorders

The esophagus is a muscular tube that carries food from the mouth to the stomach. At the lower end of this tube is a valve called the lower esophageal sphincter (LES), which normally relaxes to allow food to enter the stomach.

In achalasia cardia, the nerves controlling this process do not work properly. The esophagus loses its normal squeezing movement, and the LES fails to relax. As a result, food and liquids collect in the esophagus instead of passing smoothly into the stomach.

Common symptoms may include:

• Food getting stuck in the chest
• Difficulty swallowing solids or liquids
• Regurgitation of undigested food
• Chest pain or pressure
• Unexpected weight loss
• Coughing or choking episodes
• Heartburn-like symptoms
• Recurrent symptoms despite reflux medicines

Because achalasia is uncommon, it may be mistaken for acid reflux or GERD in the early stages.

What is Peroral Endoscopic Myotomy (POEM)?

POEM stands for Peroral Endoscopic Myotomy. It is an advanced minimally invasive procedure that treats achalasia from inside the esophagus using an endoscope.

The meaning of POEM is simple:

• Peroral: The doctor enters through the mouth
• Endoscopic: A thin flexible camera is used
• Myotomy: The tight muscle causing blockage is selectively cut
• No external cuts on the chest or abdomen
• Designed to treat the root cause of swallowing difficulty
• Performed under general anesthesia

By releasing the tight muscle at the lower end of the esophagus, POEM helps food move into the stomach more smoothly.

Identifying the Ideal Candidates for POEM

POEM is generally suitable for adults and older children with significant swallowing difficulty caused by achalasia or esophageal muscle spasms. It may be considered when symptoms are affecting nutrition, weight, sleep, or quality of life.

POEM can be especially helpful for Type III or spastic achalasia because the doctor can extend the length of the muscle cut to treat the spastic segment more effectively.

It can also work as a rescue therapy for patients whose symptoms return after balloon dilation, botox injection, or previous surgery.

Medical Contraindications and Who Should Avoid POEM

POEM is a major advancement, but it may not be suitable for every patient. Your doctor will review your reports, medical condition, and risk factors before recommending the procedure.

POEM may not be advised in patients with:

• Severe erosive esophagitis
• Liver cirrhosis with portal hypertension
• Significant bleeding or blood-clotting disorders
• Severe esophageal scarring after radiation
• Complex scarring after certain endoscopic treatments
• Medical conditions that make anesthesia unsafe

Pre-Operative Evaluation and Diagnostic Testing

Before planning POEM, your gastroenterologist needs a clear understanding of how your esophagus is functioning. This helps confirm the diagnosis and choose the right treatment approach.

Common tests may include:

These tests help separate achalasia from GERD, strictures, or other swallowing problems.

The 4-Step POEM Procedure Explained

POEM is usually performed under general anesthesia and may take around 1 to 3 hours depending on the patient and complexity of the condition.

The procedure generally involves:

Because the entire procedure is done through the mouth, there are no visible scars on the chest or abdomen.

Recovery Timeline and Clinical Outcomes

Since POEM does not involve external incisions, recovery is usually faster than traditional surgery. Some patients may go home the same day, while others may stay in the hospital for 1 to 2 nights for observation.

Recovery and results commonly include:

• Mild sore throat or temporary discomfort
• Liquid diet for the first few days
• Soft foods for about a week to 10 days
• Gradual return to a normal diet
• Improved ability to eat and drink
• Clinical success rates reported around 82% to 98%
• Durable long-term symptom relief in many patients

Your doctor will guide your diet progression and follow-up schedule based on your recovery.

POEM vs. Heller Myotomy and Pneumatic Dilatation

Traditional laparoscopic Heller myotomy (LHM) and pneumatic dilatation (PD) are also used for achalasia. The right choice depends on achalasia type, patient health, past treatment history, and specialist recommendation.

Key Advantages and Possible Risks of POEM

POEM has become an important treatment option for achalasia because it is scarless, precise, and highly customizable. It can also be useful when previous treatments have failed.

Key points include:

One important drawback is post-POEM acid reflux. Since POEM does not include an anti-reflux wrap, some patients may need acid-suppressing medicines after the procedure.

Estimated Cost of POEM and Recent Advances

The cost of POEM can vary based on the hospital, city, doctor expertise, room category, investigations, and insurance coverage. In India, the procedure may generally range between ₹1,25,000 and ₹2,15,000, though the final estimate should always be confirmed with the treating hospital.

Research is also focused on improving POEM further, especially by reducing post-procedure reflux. Current areas of study include shorter versus longer muscle cuts, different cutting positions, and combining POEM with endoscopic anti-reflux procedures in selected cases.

Consult a Gastroenterologist for POEM in Mumbai

Living with achalasia cardia can make every meal feel difficult, but the right diagnosis and treatment can help you return to eating and living more comfortably.

Dr. Sanil Parekh, Gastroenterologist and Interventional Endoscopist in Dadar and Matunga, Mumbai, provides evaluation and advanced care for complex digestive and swallowing disorders.

If you are experiencing persistent difficulty swallowing, chest pain, food regurgitation, or unexplained weight loss, book a consultation to understand whether POEM is the right treatment option for you.