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Per-oral Endoscopic Myotomy (POEM)

A POEM is most commonly used to treat:

  • Achalasia (all types)
  • Other oesophageal motility disorders, such as:
    • Spastic oesophagus
    • Jackhammer oesophagus
    • Diffuse oesophageal spasm

Symptoms that may improve include:

  • Difficulty swallowing (dysphagia)
  • Regurgitation of food or fluids
  • Chest discomfort after eating
  • Weight loss related to poor intake

How is POEM performed?

  • The procedure is done under general anaesthetic.
  • A flexible tube called an gastroscope is passed through your mouth into the oesophagus.
  • A small tunnel is created under the lining of the oesophagus.
  • The tight muscle fibres causing the blockage are carefully cut (myotomy).
  • The tunnel is sealed with tiny clips, which fall off on their own.

There are no external cuts—everything is done internally.

What are the benefits?

  • Minimally invasive: no chest or abdominal incisions
  • Effective symptom relief in over 90% of patients
  • Short hospital stay (typically 1–2 days)
  • Quicker recovery compared to traditional surgery

What are the risks?

While POEM is generally safe, potential risks include:

Possible Risk

Details

Gas-related effects

Mild bloating or shoulder pain from gas used during the procedure

Perforation

Rare, but may require further treatment or surgery

Bleeding

Usually mild and managed during the procedure

Infection

Low risk, antibiotics are given to prevent this

Reflux (acid heartburn)

Common after POEM; may need long-term acid-reducing medication

What happens after the procedure?

  • You'll stay in hospital for monitoring (usually 1 night).
  • Diet will be slowly restarted:
    • Day 1–2: Clear fluids
    • Days 3–5: Soft foods
    • Gradual return to normal diet over 1–2 weeks
  • You will be prescribed medication to reduce stomach acid (e.g., omeprazole) and antibiotics for 5 days

Long-term care

  • Follow-up appointments are important to monitor your recovery.
  • Some people may need further endoscopies or tests.
  • If reflux occurs, long-term acid suppression may be needed.
  • POEM does not cure achalasia, but it relieves the symptoms very effectively.

Frequently Asked Questions

Q: Will I be cured after POEM?
A: POEM can significantly improve symptoms, especially swallowing, but regular monitoring is still needed.

Q: How long is recovery?
A: Most people return to light activities within a few days and normal life within 1–2 weeks.

Q: Will I need another procedure in the future?
A: Rarely. POEM is long-lasting for most, but a small number may need additional treatment.

For more information, see Dr Cameron Schauer's website:

 

https://www.csgastro.co.nz/patient-information/achalasia/

 

https://www.csgastro.co.nz/patient-information/poem/