Esophageal peroral endoscopic myotomy (E-POEM) is a minimally invasive third space endoscopic procedure that treats esophageal motility disorders.
Esophageal motility disorders are a group of illnesses that affect the esophagus and the way food is transferred from your mouth to your stomach. Some common ones include achalasia, jackhammer esophagus, diffuse esophageal spasm and esophagogastric junction outlet obstruction (EGJOO).
E-POEM is an alternative to surgical Heller myotomy for esophageal motility disorders, and it may be an option for people who have persistent or recurrent symptoms after a previous surgical procedure.
Evaluation of Esophageal Motility Disorders
Your physician may conduct a series of tests to diagnose your digestive problems. These tests may include:
- Standard upper endoscopy
- High-resolution esophageal manometry
- Radiographic tests (like a barium swallow)
E-POEM is a good option for some patients but not everyone. Your physician may evaluate you in our clinic to discuss treatment options and determine if E-POEM may be right for you.
How Is the E-POEM Procedure Performed?
E-POEM is performed similarly to a standard upper endoscopy by an experienced advanced endoscopist who is specifically trained in third space endoscopy. The procedure is performed under general anesthesia and generally takes an hour to an hour and a half to complete.
Once you are under anesthesia, the physician uses a thin, flexible endoscope to navigate into your throat. Then, a superficial incision is made within the esophagus and a tunnel is created between the layers of the esophagus to reach the tight esophageal sphincter. A permanent cut (called a myotomy) of the sphincter muscle is then performed to help food pass into the stomach more easily.
After Your E-POEM Procedure
This procedure is routinely performed on an outpatient basis, although your physician may elect to admit you for an overnight stay in the hospital for monitoring. Nausea and pain medications are sometimes needed, but most patients have no symptoms 24 to 48 hours after the procedure. Your physician may order imaging tests to ensure the surgical area is intact before you can start a diet.
Going Back Home and to Work
After your procedure, you’ll complete a short course of antibiotics to prevent infection. Your diet will progress to a soft diet after the first three days following your E-POEM procedure, and then you can advance your oral intake as tolerated. You may resume all home medications unless otherwise instructed by your physician.