Achalasia is an uncommon disease that is characterized by spasm of the lower esophageal sphincter (LES). Patients with achalasia present with inability to swallow food, frequent vomiting, weight loss, and malnutrition. Until recently, treatment for achalasia involved either Botox injection into the LES (which provides only temporary relief of symptoms) or surgical "Heller myotomy" where the LES is cut via laparoscopic access to the upper abdomen.
Morristown Medical Center
In 2011, an innovative endoscopic technique known as Per Oral Endoscopic Myotomy, or POEM, was developed in Japan. This procedure involves creating an incision in the mucosa of the esophagus through which the endoscope is passed. The endoscope is then tunneled through the wall of the esophagus to the level of the LES. Under magnified endoscopic views, the LES is carefully cut. The scope is withdrawn from the tunnel and the mucosal incision is closed using sutures or clips.
After POEM, patients with achalasia experience immediate improvement in their ability to swallow food.
Matthew Grossman, MD
POEM has been shown in a 2019 New England Journal of Medicine review to be equivalent to surgical myotomy in relief of achalasia symptoms. Both POEM and surgical myotomy procedures have an increase in reflux (GERD) after the myotomy is performed. This side-effect of the procedure is usually controlled with antacid medication.
POEM has recently become a standard of care for treatment of achalasia. It is less invasive than surgical myotomy. It also allows for myotomy much higher into the body of the esophagus than surgical myotomy can access. This is especially helpful for variants of achalasia that have spasm of the body of the esophagus in addition to the LES spasm (type III achalasia).
POEM was invented in 2011 by Japanese physician Hiro Inoue. This procedure was first performed in the USA in 2014. The first POEM in New Jersey was performed by Dr. Matthew Grossman in 2017. Dr. Grossman has performed over 300 POEM procedures with excellent outcomes.
Dr. Grossman, alongside Dr. Nnaemeka Anyadike, performs POEM procedures routinely at Atlantic Health System's Morristown Medical Center for achalasia patients. Patients spend one night in the hospital post procedure and return home the next day.
The POEM technique has been modified to help patients with gastroparesis -
- where stomach emptying is limited. Instead of cutting LES, this gastric POEM or "G-POEM", cuts the pylorus (the exit muscle of the stomach), aiding in gastric emptying.
POEM was the first procedure that involved passage of the endoscope beyond the lumen of the GI tract. Such procedures are becoming more common as we enter the era of "endoscopic surgery".
The Atlantic Digestive Health Institute also performs extended myotomy procedures for patients with other types of esophageal spasm, such as distal esophageal spasm (DES) or Jackhammer esophagus.