Per oral endoscopic myotomy ( POEM)

Per oral endoscopic myotomy (POEM) is an advanced endoscopic procedure used in the treatment and management of patient with oesophageal motor disorders, such as achalasia. 

This procedure is performed during a gastroscopy (endoscopy) under general anaesthesia. 

It was first performed in Japan in 2008 (H Inoue), and has since become the current best treatment option for achalasia. 

What is Achalasia?

Achalasia is a rare oesophageal disorder (1 in 100,00) that is characterized by the failure of lower esophageal sphincter to relax in addition to the absence or abnormal contraction of the oesophagus.

It can affect patients of all ages, but typically between 25 – 60 years of age.

Difficulty swallowing is the most common symptom, along with chest pain, regurgitation and weight loss.   

What is the cause of Achalasia?

Achalasia is a condition in which the nerve fibres of the oesophagus are damaged and no longer adequately work. There is currently no clear reason for this nerve degeneration.

What are the treatment options for Achalasia?

• Medication-typically this results in poor response of symptoms, and so this treatment is rarely used currently
• Botox (botulinum toxin A) injections- temporarily paralyses the lower oesophageal muscle. It is administered during a gastroscopy procedure. Variable and short lived symptom response, so often used only in cases where other treatments are not appropriate.
• Pneumatic dilatations- Balloon dilation (at endoscopy/gastroscopy) to stretch and tear the lower esophageal muscle. Most patients will require more than one dilatation. This treatment option may be considered if more definitive treatments are not appropriate. 
• Laproscopic Heller’s Myotomy (LHM) with or without an anti-reflux procedure. This a surgical procedure that precisely cuts the muscle of the lower oesophagus and relieve the obstruction at the end of the oesophagus. 
• Per Oral Endoscopic Myotomy (POEM). This is an advanced endoscopic procedure that precisely cuts the muscles of the lower oesophagus.  It is similar to a Heller’s Myotomy, except done via a gastroscope through the mouth. Recent studies have demonstrated that POEM procedure is as good, if not better, than the surgical option of LHM.

Per-oral endoscopic myotomy (POEM) is an advanced endoscopic procedure that requires further training and expertise that what is typical of most doctors performing endoscopic procedures.

Dr Michael Swan has trained alongside world leaders in this procedure in high volume Australian and international hospitals. In addition he has attended multiple workshops, courses and conferences on this advanced endoscopic technique.  Since 2018, he is one of the few trained doctors that regularly perform this procedure in both public and private hospitals in Melbourne. Michael is able to perform this procedure at Monash Health (Clayton) and privately at Jessie Macpherson and Holmesglen Private Hospitals. 

Michael is regularly referred patients diagnosed with achalasia from other specialists for further management for their condition.