POEM for Achalasia in Surat What to Expect
POEM (per-oral endoscopic myotomy) treats achalasia - a condition in which the muscle at the lower end of the food pipe fails to relax - by cutting that muscle from inside through the endoscope, without any incision on the body.
What is POEM?
In achalasia, food collects in the food pipe because the lower valve stays tight and the food pipe does not push properly. POEM creates a tunnel within the wall of the food pipe from inside, divides the tight muscle fibres, and closes the entry with clips. It achieves the same result as surgical myotomy through the mouth alone.
The diagnosis is confirmed first with manometry in our GI motility lab and an endoscopy. POEM is performed under general anaesthesia by our medical gastroenterologist at Adajan, with a short hospital stay.
When is POEM Recommended?
Your doctor may recommend it for:
- Achalasia confirmed on manometry, causing difficulty swallowing, regurgitation or weight loss See: difficulty swallowing
- Some other spastic disorders of the food pipe
- Achalasia that has recurred after previous treatment, in selected patients
POEM is only offered once manometry has confirmed achalasia or a related motility disorder - the test decides the treatment.
Your POEM Stay: Step by Step
POEM is a planned procedure with a short hospital stay - usually one to two nights. The procedure takes one to two hours.
- Diagnosis and planning
Manometry in our GI motility lab and an endoscopy confirm achalasia and plan the length of the myotomy; an anaesthetic assessment is done.
- Admission
Admission at the main hospital in Adajan, usually after a liquid-only diet for a day or two so the food pipe is clear.
- The procedure
One to two hours under general anaesthesia (described in the next section).
- In hospital
Usually one to two nights. A contrast X-ray may be done the next day to check the closure; you start with liquids.
- Going home and after
A soft diet for about a week, then gradually normal food. Follow-up in clinic checks your swallowing.
What Happens During POEM
General anaesthesia is given
The endoscope is passed into the food pipe; a small opening is made in the lining
A tunnel is created within the wall down to the lower valve and slightly beyond
The inner muscle layer is divided along the length of the tunnel
The entry point is closed with clips
The procedure takes one to two hours
What you will feel - and what you won't. You are under general anaesthesia for the whole procedure and feel nothing. Afterwards, chest or throat discomfort for a few days is common and settles. The change most patients notice is the one they came for: food goes down. Because the valve has been loosened, some acid reflux can occur and is treated with medicines if needed.
How to Prepare for POEM
- Diagnosis first. Manometry and endoscopy to confirm the diagnosis and plan the length of the myotomy.
- A clear food pipe. A liquid-only diet for a day or two beforehand may be advised so the food pipe is clear.
- Anaesthetic assessment. An anaesthetic assessment is done before the procedure.
These are general points. The written instructions you receive from the hospital for your own procedure take priority - see also Patient Information.
After POEM: Recovery, Diet & Follow-up
In hospital. Usually one to two nights in hospital. A contrast X-ray may be done the next day to check the closure.
Eating again. Liquids first, then a soft diet for about a week, then gradually normal food. Chest or throat discomfort for a few days is common.
Reflux and follow-up. Acid reflux can occur after POEM and is treated with medicines if needed. Follow-up in clinic to check swallowing.
Is POEM Safe?
POEM is safe in experienced hands. The main risks are bleeding, infection, a leak from the tunnel, and air escaping into the chest or abdomen, which usually settles.
Acid reflux after the procedure is common and is managed with tablets; a minority need longer-term treatment.
Contact the hospital if you develop severe chest or abdominal pain, fever, breathlessness or vomiting after the procedure.
After a procedure, contact the hospital at once for severe pain, fever, vomiting, bleeding or breathlessness: Emergency 24×7: 90333 62020
Alternatives to POEM
Pneumatic balloon dilatation stretches the valve through an endoscope; effective but often needs repeating.
Laparoscopic Heller's myotomy is the surgical equivalent, done through small abdominal incisions and usually combined with an anti-reflux procedure.
Botulinum toxin injection gives temporary relief for patients not fit for other treatments.
Why Choose Gujarat Hospital for POEM
POEM is a specialist procedure, and its result depends on the diagnosis being right, the myotomy being planned from real measurements, and the care around it. At Gujarat Gastro & Vascular Hospital, Adajan, Surat:
- Diagnosis in our own GI motility lab. Manometry and endoscopy are done here by the same team, so the length of the myotomy is planned from your own measurements rather than assumed.
- Performed under general anaesthesia by our medical gastroenterologist, with full monitoring, and a short stay in hospital so that the first day - when any problem would show - is spent under observation, not at home.
- Reflux checked and managed afterwards. Follow-up in clinic checks your swallowing, and reflux after POEM is picked up and treated by the same doctors - including pH studies in the motility lab if needed.
- All the alternatives under one roof. Pneumatic dilatation, botulinum toxin injection and laparoscopic Heller's myotomy by our GI surgical team are all available here, so the choice is made on what suits you, not on what the hospital can offer.
Frequently Asked Questions about POEM
Is POEM permanent?
The muscle division is permanent, and relief is long-lasting for most patients. A small number need further treatment over the years.
Will I be asleep?
Yes. POEM is done under general anaesthesia - you are fully asleep and feel nothing. An anaesthetic assessment is done beforehand, and you are monitored throughout and afterwards.
Will I get acid reflux?
Some patients do, because the valve has been loosened. It is usually mild and controlled with acid-suppressing medicine.
How long will I be in hospital?
Usually one to two nights. A contrast X-ray may be done the next day to check the closure, and you go home once you are drinking comfortably.
How is it different from dilatation?
Dilatation stretches the muscle and often needs repeating; POEM divides it and gives more durable relief.
Can POEM be done if I have already had balloon dilatation?
Yes, in selected patients. Achalasia that has come back after dilatation, or after a previous myotomy, can be treated with POEM, as the endoscopic tunnel can be made in an untouched part of the wall. Manometry and endoscopy are repeated first to confirm that the muscle is still the problem, and your doctor will decide whether it is suitable.
What can I eat after POEM?
Liquids first, then a soft diet for about a week, then gradually normal food. Your written instructions and the follow-up visit guide the steps; most people are eating a normal diet within a few weeks.
How soon can I return to work after POEM?
Most people are back to desk work within about a week, once they are on a soft diet and the chest or throat discomfort has settled. Heavy physical work should wait a little longer and until the clinic has confirmed the entry point has healed. Your doctor will give you a date based on your recovery.
The information on this page is for general patient education and does not replace individual medical advice, diagnosis or treatment. Medical Disclaimer