POEM is a minimally invasive procedure that uses a high definition endoscope (a flexible tube with a mounted camera at end) to help treat certain swallowing disorders and stands for Peroral Endoscopic Myotomy. Who cannot undergo this procedure? Although POEM is a safe and effective procedure, it may not be a suitable option in certain cases. People with any of the following conditions are generally not recommended to undergo POEM for achalasia: 1. Disorders of coagulation 2. History of any kind of therapy that is likely to compromise the integrity of the mucosa of the esophagus or lead to fibrosis of the submucosa for e.g. radiation for cancer treatment, endoscopic mucosal resection, or radiofrequency ablation 3. Liver cirrhosis with portal hypertension 4. Severe erosive esophagitis When should it be done? POEM is generally indicated for treating the following disease: 1. Achalasia: It is a medical condition that affects the muscles of the esophagus. The lower esophageal sphincter (LES), a muscular valve present between the esophagus and the stomach fails to relax during swallowing in this condition. 2. Diffuse esophageal spasm: Esophageal disorders of muscle spasm that are unresponsive to medical therapies 3. Nutcracker esophagus also known as hypertensive peristalsis is a muscle spasm disorder which needs surgical correction.

1. Peroral Endoscopic
Myotomy
(POEM)

2. What Is POEM?
It is a minimally invasive
procedure that uses high
definition endoscope
(a flexible tube with a mounted
camera at one end) to help treat
certain swallowing disorders.

3. Why Is POEM Done?
• POEM is done to open up the
narrowed muscular sphincter
present between the esophagus and
stomach
• This allows the food to pass easily
into the stomach.

4. Indications Of POEM
It is indicated to manage symptoms of :
• Achalasia (a condition, in which the
esophagus (food pipe) is unable to
move the food in the stomach)
• Diffuse esophageal spasm
(contraction of esophagus in
uncoordinated way along with
regurgitation)
• Nutcracker esophagus (severe
esophageal spasm that may be
associated with chest pain)

5. Who Are Eligible For POEM?
People with symptomatic, primary idiopathic achalasia
are ideal candidates for POEM.

6. How Is The Procedure Is Done?
An endoscope is passed
via mouth into the
esophagus.

7. The surgeon views the
site of defect in the
monitor.
How Is The Procedure Is Done?

8. An incision is made in the
lining of the esophagus
above gastroesophagal
sphincter.
How Is The Procedure Is Done?

9. This allows the entry of the
endoscope inside the wall
of esophagus to expose
the muscles.
How Is The Procedure Is Done?

10. Now, the inner layer of the
muscle near the lower
esophageal sphincter
(bundle of muscles at the
lower end of esophagus) is
cut by using a specialized
knife.
How Is The Procedure Is Done?

11. Now, the inner layer of the
muscle near the lower
esophageal sphincter
(bundle of muscles at the
lower end of esophagus) is
cut by using a specialized
knife.
How Is The Procedure Is Done?

12. Benefits Of POEM
Safer Lower rate of complications
Quicker recovery Better Outcomes

13. POEM Success Rate
94% 91% 90%
POEM is safe and effective with a clinical success rate of 94%, 91%,
and 90% at 1,2, and 3 years respectively.
Source:Sharata A, et.al. Peroral Endoscopic Myotomy (POEM) Is Safe and Effective in the Setting of Prior Endoscopic
Intervention. Journal of Gastrointestinal Surgery. 2013; 17 (7).