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Per-Oral Endoscopic Myotomy(POEM)

Per-Oral Endoscopic Myotomy(POEM)

 

Overview

Due to abnormal eating conditions, patients of achalasia gradually reduce their social activities, seriously affecting their quality of life. POEM can improve the patient's symptoms. In addition, POEM also has efficacy for other esophageal motility disorders, such as high-pressure obstruction of the esophagogastric junction and distal esophageal contractions.

 

Features Summary

Achalasia is a rare esophageal motility disorder caused by loss of esophageal muscle contraction function and relaxation dysfunction of the lower esophageal sphincter, leading to difficulty swallowing. Initial symptoms may include occasional heartburn, difficulty belching, and over several months to years, swallowing difficulties and chest pain may occur. In severe cases, symptoms such as vomiting after eating and weight loss may also occur. Without treatment, patients with achalasia can develop progressive dilatation of the esophagus. Late- or end-stage achalasia is characterized by esophageal tortuosity, angulation, and severe dilation or megaesophagus(diameter >6 cm). Treatment for achalasia include pneumatic dilation, laparoscopic Heller myotomy with a partial fundoplication and POEM.

 

Procedure

Per-Oral Endoscopic Myotomy (POEM) is a minimally invasive endoscopic surgery used to treat esophageal motility disorders. This procedure uses a esophagogastroduodenoscopy and a specialized endoscopic surgical knife to create a tunnel through the submucosal layer of the esophagus that leads directly to the gastroesophageal junction. The tunnel is then used to cut the lower esophageal sphincter and abnormal muscle contractions in the esophagus, achieving similar results to traditional surgery. This endoscopic surgery has advantages such as no external incisions, rapid postoperative recovery, and safety compared to traditional treatments. The treatment effect is also comparable to or better than traditional treatments, especially for type III achalasia.

 

Notification

Potential risks and complications include:

Nearly half of the patients may experience subcutaneous emphysema, mediastinal emphysema, and abdominal distension after surgery, but the gas will be absorbed on its own without causing clinical effects. In addition, 2.5% of patients may develop pneumothorax, and 1% may have bleeding or infection. Overall, serious side effects occur in about 3.2% of cases, which can mostly be treated with conservative or antibiotic therapy.

 

Estimated Cost

For estimated medical costs, please contact International Medical Services Center.

 

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