Per Oral Endoscopic Myotomy (POEM)

Washington University minimally invasive surgeons perform per oral endoscopic myotomy (POEM), a minimally invasive procedure for achalasia performed via endoscope through the mouth.

Achalasia is a rare swallowing disorder in which the esophagus is unable to move food into the stomach. Laparoscopic Heller myotomy – in which surgeons access the esophagus through small abdominal incisions – has been the procedure of choice since the 1990s. Before then, surgeons performed the Heller myotomy as an open surgery through the chest or the abdomen.

POEM is the least invasive treatment for achalasia, using incisionless surgery to relax the muscle that connects the esophagus to the stomach. Studies have shown POEM and laparoscopic Heller myotomy have similar success rates, and POEM may result in improved clinical outcomes because it allows for a longer myotomy*, which involves the cutting of the esophageal sphincter muscle.

Japanese surgeon Hirano Inoue, MD, performed the first POEM in 2009, and since then the popularity of the procedure has grown. POEM is a highly technical procedure, and a limited number of U.S. centers offered it when it was first performed by a Washington University surgeon and interventional endoscopist at Barnes-Jewish Hospital in 2013. Now a team of two Washington University minimally surgeons perform about 30 POEM procedures a year.
Washington University in St. Louis minimally invasive surgeons who perform POEM:

• Michael Awad, MD, PhD
• Jeffrey Blatnik, MD

*Kumbhari V et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015 Jun; 3(3): E195–E201.