POEM – Peroral Endoscopic Myotomy in Indore
Peroral Endoscopic Myotomy (POEM) is an advanced minimally invasive endoscopic procedure used primarily to treat achalasia, a disorder in which the lower esophageal sphincter does not relax normally and the esophagus has difficulty moving food into the stomach.
Patients with achalasia may experience difficulty swallowing, regurgitation, chest discomfort and a sensation that food is getting stuck. Over time, these symptoms can affect eating, nutrition and quality of life.
POEM treats the underlying muscular obstruction by creating an endoscopic tunnel within the wall of the esophagus and carefully cutting selected muscle fibres that contribute to the abnormal resistance to food passage.
Dr. Amol Patil is a Senior Consultant Gastroenterologist and Hepatologist with more than 15 years of clinical experience, Fellowship in Advanced Endoscopy and particular expertise in procedures such as POEM.
What Is POEM?
POEM stands for Peroral Endoscopic Myotomy. It is an advanced endoscopic technique designed to reduce abnormal muscle resistance at the lower end of the esophagus.
Unlike conventional surgery, POEM is performed through the mouth using a flexible endoscope. There is no external skin incision.
During the procedure, the gastroenterologist creates a small entry point in the esophageal lining and develops a controlled tunnel within the wall of the esophagus. The muscle fibres responsible for the impaired relaxation are then divided. The entry point is subsequently closed using endoscopic techniques.
By reducing the abnormal muscular resistance, POEM can allow food and liquids to pass more effectively from the esophagus into the stomach.
What Is Achalasia?
Achalasia is a rare esophageal motility disorder in which the lower esophageal sphincter does not relax normally during swallowing. The coordinated movement of the esophagus may also become impaired.
As a result, food and liquids can remain in the esophagus instead of passing normally into the stomach.
Common symptoms include:
- Difficulty swallowing food or liquids
- Regurgitation of undigested food
- Chest discomfort or pressure
- Sensation of food sticking in the chest
- Difficulty eating normally
- Weight loss in some patients
- Coughing or choking, particularly at night
- Symptoms that worsen gradually over time
The severity and pattern of symptoms can vary considerably between patients.
When Is POEM Recommended?
POEM is primarily considered for patients with achalasia and selected esophageal motility disorders where reducing abnormal muscle resistance is an appropriate treatment strategy.
A specialist may consider POEM when patients have:
- Confirmed achalasia
- Persistent swallowing difficulty
- Regurgitation related to impaired esophageal emptying
- Symptoms affecting nutrition or daily life
- An esophageal motility disorder that may benefit from endoscopic myotomy
- Recurrence or persistent symptoms after selected previous treatments, depending on the individual case
The decision to perform POEM requires careful assessment of the patient’s symptoms, esophageal anatomy, motility findings and previous treatment history.
Symptoms That May Suggest Achalasia
Achalasia can develop gradually, and symptoms may initially be mistaken for acidity or other digestive problems.
Important symptoms include:
- Difficulty swallowing solids and liquids
- Food or liquid coming back into the mouth
- Chest pain or pressure after eating
- Regurgitation, particularly at night
- Persistent sensation of food remaining in the esophagus
- Unexplained weight loss
- Coughing or choking at night
- Increasing difficulty eating normally
Persistent difficulty swallowing should be evaluated by a gastroenterologist rather than being assumed to be simple acidity.
How Is Achalasia Diagnosed in Indore?
A detailed evaluation is important before considering POEM.
Depending on the patient’s symptoms, investigations may include:
Upper GI Endoscopy
Upper GI endoscopy allows the gastroenterologist to examine the esophagus and stomach and exclude other causes of swallowing difficulty.
Esophageal Manometry
Esophageal manometry is an important test for assessing the movement and pressure patterns of the esophagus. It can help confirm achalasia and classify the underlying motility disorder.
Barium Swallow
A contrast swallow study may provide information about esophageal emptying, dilation and the appearance of the lower esophageal region.
Additional Investigations
Other investigations may be considered based on the patient’s symptoms and previous findings.
The diagnosis is established by combining clinical symptoms with appropriate investigations rather than relying on a single test.
How Is POEM Performed?
POEM is performed through the mouth using a specialised endoscope.
The general procedure involves:
- Pre-procedure evaluation: The gastroenterologist reviews symptoms, diagnostic reports and medical history.
- Preparation: The patient receives specific fasting and medication instructions.
- Anaesthesia: POEM is performed under appropriate anaesthesia.
- Endoscopic entry: The endoscope is introduced through the mouth into the esophagus.
- Creation of a submucosal tunnel: A controlled tunnel is created within the wall of the esophagus.
- Myotomy: Selected muscle fibres are carefully divided to reduce the abnormal resistance at the lower esophageal sphincter.
- Closure: The entry point in the esophageal lining is closed using endoscopic closure techniques.
- Recovery and monitoring: The patient is observed after the procedure and receives individualized post-procedure instructions.
The exact technique and extent of myotomy depend on the type of achalasia and the patient’s individual anatomy and clinical findings.
POEM for Different Types of Achalasia
Achalasia is commonly classified into different subtypes based on esophageal motility findings.
The major types include:
- Type I achalasia: Characterized by minimal pressurization within the esophagus.
- Type II achalasia: Associated with increased pressurization of the esophagus during swallowing.
- Type III achalasia: Characterized by abnormal or premature esophageal contractions.
The treatment approach can vary depending on the subtype and other clinical factors.
POEM can be particularly relevant when the muscle treatment needs to be tailored to the patient’s specific esophageal motility pattern.
What Are the Benefits of POEM?
The potential benefits of POEM depend on the patient’s diagnosis and individual circumstances.
POEM offers several important features:
- Performed through the mouth rather than through an external surgical incision
- Direct endoscopic access to the esophageal muscle
- Ability to tailor the myotomy to the patient’s anatomy and motility disorder
- Minimally invasive approach
- Can be considered for selected patients with different achalasia subtypes
- May be an option for selected patients who have persistent or recurrent symptoms after previous treatment
The expected benefits and limitations should be discussed with the treating gastroenterologist before the procedure.
Recovery After POEM
Patients are monitored after POEM and receive specific instructions regarding recovery and diet.
The immediate recovery plan may include:
- Medical observation after the procedure
- Gradual progression of oral intake according to the treating team’s instructions
- Monitoring for symptoms or complications
- Follow-up assessment
- Evaluation of swallowing symptoms over time
The recovery period varies between patients depending on their clinical condition and the specifics of the procedure.
Risks and Safety of POEM
POEM is an advanced endoscopic procedure and, like any intervention, carries potential risks.
Possible complications can include:
- Bleeding
- Infection
- Leakage from the tunnel or closure site
- Air or gas-related discomfort
- Reflux symptoms after the procedure
- Adverse reactions related to anaesthesia
- Other procedure-specific complications
The risk depends on factors such as the patient’s anatomy, underlying condition and the complexity of the procedure.
A specialist evaluation before POEM is important to determine whether the procedure is appropriate and to discuss potential benefits and risks.
POEM and Gastroesophageal Reflux
Because POEM involves cutting muscle fibres that normally contribute to the barrier between the esophagus and stomach, some patients may develop or experience increased reflux symptoms after treatment.
Patients may therefore require follow-up after POEM to assess swallowing, reflux symptoms and overall response to treatment.
The appropriate management of reflux after POEM is individualized according to the patient’s symptoms and clinical findings.
Advanced POEM Expertise by Dr. Amol Patil
Dr. Amol Patil is a Senior Consultant Gastroenterologist and Hepatologist with more than 15 years of clinical experience. His qualifications include MBBS, MD (Medicine), DM (Gastroenterology) from CMC Vellore and a Fellowship in Advanced Endoscopy.
The provided practice information specifically identifies particular expertise in procedures such as POEM, making this an important part of his advanced endoscopy profile. The source also describes his extensive experience in complex gastrointestinal disorders and advanced diagnostic and interventional endoscopy.
His broader advanced endoscopy expertise includes ERCP and EUS, and he has contributed to training gastroenterologists and surgeons in advanced endoscopy and EUS at national and international platforms.
This experience is relevant for patients with complex esophageal motility disorders who require detailed diagnostic evaluation and consideration of advanced endoscopic treatment.
Advanced Esophageal & Endoscopy Care in Indore
Management of achalasia requires accurate diagnosis before selecting a treatment.
Specialist-led care may include:
- Detailed evaluation of swallowing symptoms
- Upper GI endoscopy
- Esophageal motility assessment
- Review of previous investigations
- Assessment of achalasia subtype
- Discussion of available treatment options
- Advanced endoscopic treatment when appropriate
- Follow-up after treatment
POEM is not automatically appropriate for every patient with difficulty swallowing. The treatment decision should be based on the confirmed diagnosis and individual clinical circumstances.
Personalized Patient Care
A successful treatment pathway begins with an accurate understanding of why swallowing is difficult.
A personalized approach includes:
- Detailed symptom assessment
- Review of medical history
- Evaluation of swallowing pattern
- Appropriate diagnostic testing
- Confirmation of the underlying motility disorder
- Discussion of treatment options
- Assessment of suitability for POEM
- Explanation of the procedure and potential risks
- Post-procedure follow-up
This allows treatment decisions to be based on the patient’s diagnosis, anatomy, symptoms and previous treatment history.
Why Choose Dr. Amol Patil for POEM in Indore?
- 15+ years of clinical experience in gastroenterology and hepatology.
- DM (Gastroenterology) from CMC Vellore with Fellowship in Advanced Endoscopy.
- Particular expertise in POEM, as documented in the provided practice information.
- Extensive experience with complex gastrointestinal disorders.
- Extensive expertise in diagnostic and interventional endoscopy.
- More than 25,000 patients treated according to the provided practice information.
- More than 10,000 diagnostic and interventional endoscopic procedures annually according to the provided practice information.
- A specialist-led approach combining detailed diagnosis with advanced endoscopic treatment planning.
When Should You See a Gastroenterologist?
Persistent difficulty swallowing should be evaluated by a gastroenterologist, particularly when symptoms are progressive or associated with other concerning features.
Seek specialist evaluation for:
- Difficulty swallowing solids or liquids
- Progressive swallowing difficulty
- Frequent regurgitation of food or liquids
- Recurrent chest discomfort associated with swallowing
- Unexplained weight loss
- Night-time coughing or choking
- Food repeatedly feeling stuck in the chest
- Persistent symptoms despite treatment for presumed acidity or reflux
A gastroenterologist can determine whether the symptoms are related to achalasia, another esophageal motility disorder, reflux or a structural condition.
Frequently Asked Questions
Expert POEM & Advanced Endoscopy Care in Indore
Peroral Endoscopic Myotomy provides an advanced endoscopic treatment option for appropriately selected patients with achalasia and certain esophageal motility disorders. Accurate diagnosis, careful patient selection and specialist endoscopic expertise are important parts of the treatment pathway.
Dr. Amol Patil’s provided practice profile specifically identifies particular expertise in POEM, alongside extensive experience in complex gastrointestinal disorders and advanced endoscopy.
Book an Appointment with Dr. Amol Patil for specialist evaluation of achalasia and personalized POEM treatment planning in Indore.