Achalasia treatment
Per-oral endoscopic myotomy (POEM) treats achalasia from inside the food pipe, with no cuts on the skin. Consultation and manometry planning at Medigest, West Punjabi Bagh, Delhi; the procedure is done at Apollo Hospitals by Dr. Shrihari Anikhindi.
Overview
In achalasia cardia, the valve at the lower end of the food pipe stays tight and the food pipe stops pushing food down. Food and water get stuck in the chest, come back up, and many people slowly lose weight.
POEM loosens that valve from the inside. An endoscope is passed through the mouth, a small tunnel is made within the wall of the food pipe, and the tight inner muscle is cut along its length. Nothing is cut on the outside of the body, so there are no scars and recovery is quick. POEM is now a standard treatment for achalasia in India and around the world.
Who it helps
The decision is made after an endoscopy, a barium swallow and esophageal manometry.
POEM procedure
Not every swallowing problem is achalasia. An upper GI endoscopy first rules out a narrowing or growth. Esophageal manometry then confirms achalasia and shows its type, which matters when choosing treatment. A barium swallow shows how wide the food pipe has become and how slowly it empties. Read the common signs of achalasia and our guide to difficulty swallowing.
POEM is done under general anaesthesia and takes about one to two hours. A small opening is made in the lining of the food pipe, a tunnel is created under it, and the tight muscle is divided down to and just past the valve. The opening is then closed with clips. Most people start sips of water the next day and go home after one or two nights.
Around nine in ten patients swallow much better after POEM, and the relief lasts for years in most. The main trade-off is acid reflux, because the valve is now looser. Many people need an acid-reducing tablet afterwards, and a check endoscopy is planned to look for reflux damage. We compare the options in detail in POEM vs Heller myotomy.
Balloon (pneumatic) dilatation stretches the valve during an endoscopy and suits some patients, though it may need repeating. Laparoscopic Heller myotomy is keyhole surgery with a partial wrap to limit reflux. Botox injections help for a few months and are kept for people who are not fit for other treatment. There is no tablet that cures achalasia.
Dr. Shrihari Anikhindi trained in advanced endoscopy in Japan and in gut motility in South Korea. Patients from Delhi NCR start with a consultation at Medigest in West Punjabi Bagh, where reports are reviewed and manometry is planned. The POEM procedure is performed at Apollo Hospitals, and follow-up can be at the clinic or online. POEM is part of our advanced endoscopy services.
Your journey
Bring earlier endoscopy, barium swallow and manometry reports if you have them.
Symptoms, weight and earlier treatments are reviewed.
Endoscopy, manometry and barium swallow as needed.
Done under anaesthesia, usually one to two nights in hospital.
Diet advice, reflux check and a review endoscopy.
FAQ
POEM is an endoscopic procedure, not open or keyhole surgery. It is done through the mouth under general anaesthesia, with no cuts on the skin. It does need a short hospital stay.
Most people start sips of water the next day, go home after one or two nights, follow a soft diet for about two weeks and return to desk work within a week.
The cost depends on the hospital, room category and length of stay. After reviewing your reports the clinic gives you an estimate. POEM is a hospital procedure and is usually covered by health insurance; check your policy and ask the hospital desk for pre-authorisation.
Some people do, because the tight valve is loosened. It is usually controlled with an acid-reducing tablet. A check endoscopy after the procedure looks for any reflux damage.
Relief lasts for many years in most patients. If symptoms return, they can usually be treated with a balloon dilatation or a repeat procedure.
Book a consultation at Medigest Gastro, Liver & Endoscopy Clinic, 63, West Avenue Road, West Punjabi Bagh, New Delhi 110026, or start with an online consultation. The POEM procedure itself is performed at Apollo Hospitals.
Appointments
Visit the clinic in West Punjabi Bagh, or book an online consultation from home.
