Overview
Peroral Endoscopic Myotomy (POEM) is a minimally invasive endoscopic procedure used to treat achalasia, a condition where the lower esophageal sphincter (LES) fails to relax, causing difficulty swallowing, regurgitation, and chest discomfort.
South Korea is a leading country for advanced endoscopic and gastroenterological procedures, offering highly skilled specialists, precise endoscopic techniques, and comprehensive post-operative care for patients with esophageal motility disorders.
What is Peroral Endoscopic Myotomy (POEM)?
POEM is an endoscopic procedure performed through the mouth, eliminating the need for external incisions. The procedure involves:
✔ Creating a submucosal tunnel in the esophagus.
➔ Cutting the inner circular muscle layer of the lower esophageal sphincter.
● Preserving the mucosal layer to prevent perforation or leakage.
★ Restoring normal swallowing function by reducing LES pressure.
It is considered a safe and effective alternative to traditional surgical myotomy (Heller myotomy), especially for patients preferring a minimally invasive approach.
What are the Benefits?
POEM offers several advantages:
✔ Minimally invasive—no external incisions required.
➔ Rapid symptom relief from dysphagia, regurgitation, and chest discomfort.
● Shorter recovery time compared to traditional surgery.
★ Effective for all types of achalasia, including complex or recurrent cases.
➤ Preserves esophageal function and maintains quality of life.
Procedure Details
1) How should I prepare for Peroral Endoscopic Myotomy (POEM)?
Preparation ensures safety and optimal outcomes:
✔ Medical evaluation: Esophageal manometry, endoscopy, and imaging.
➔ Medication review: Blood thinners and anticoagulants may need temporary discontinuation.
● Fasting: Typically 8–12 hours before the procedure.
★ Patient counseling: Discuss procedure, benefits, risks, and recovery expectations.
➤ Pre-procedure hygiene: Oral cleaning to reduce infection risk.
2) What happens during the procedure Peroral Endoscopic Myotomy (POEM)?
The procedure is performed under general anesthesia and usually lasts 1–2 hours:
✔ Endoscopic access: Flexible endoscope inserted through the mouth into the esophagus.
➔ Submucosal tunnel creation: A tunnel is made between the mucosal and muscular layers.
● Myotomy: Circular muscle fibers of the lower esophageal sphincter are carefully cut.
★ Closure: Mucosal entry site is closed with clips to prevent leakage.
➤ Monitoring: Continuous assessment for bleeding or perforation.
Korean gastroenterologists often use high-definition endoscopes and advanced imaging for precise myotomy.
3) What happens after Peroral Endoscopic Myotomy (POEM)?
Post-procedure care focuses on healing, symptom monitoring, and diet progression:
✔ Hospital stay: Typically 1–2 days for observation.
➔ Pain management: Mild discomfort managed with medications.
● Diet progression: Liquid diet initially, advancing to soft and then regular diet as tolerated.
★ Follow-up endoscopy: Ensures mucosal healing and evaluates myotomy success.
➤ Lifestyle adjustments: Avoid heavy meals initially and adhere to dietary recommendations.
Risks / Benefits
Possible Risks:
✔ Esophageal perforation (rare due to advanced endoscopic technique)
➔ Infection or mediastinitis
● Bleeding during or after procedure
★ Reflux or gastroesophageal reflux disease (GERD) post-procedure
➤ Rare complications: delayed mucosal healing or strictures
Major Benefits:
✔ Minimally invasive with no external incisions
➔ Rapid relief from achalasia symptoms
● Short recovery time with early return to normal activities
★ Effective for all types of achalasia, including recurrent cases
➤ Advanced Korean endoscopy centers provide high procedural safety and expertise
Recovery and Outlook
✔ Initial recovery: Liquid diet for several days, followed by soft foods.
➔ Symptom improvement: Dysphagia relief usually observed within days.
● Follow-up: Regular endoscopy and manometry to assess outcomes.
★ Long-term outcome: Sustained improvement in swallowing, reduced regurgitation, and enhanced quality of life.
➤ Lifestyle: Patients resume normal activities within a few days; dietary modifications may be needed to prevent reflux.
When To Call the Doctor
Seek immediate attention if you experience:
✔ Chest pain or severe discomfort
➔ Fever, chills, or signs of infection
● Difficulty swallowing or persistent vomiting
★ Vomiting blood or black stools
➤ Unusual abdominal pain or bloating
Best Korea Option / Process
South Korea provides world-class POEM care with:
✔ Leading hospitals: Samsung Medical Center, Asan Medical Center, Seoul National University Hospital.
➔ Expert gastroenterologists: Highly trained in advanced endoscopic techniques.
● State-of-the-art endoscopy suites: High-definition imaging, CO₂ insufflation, and advanced closure devices.
★ Comprehensive post-procedure care: Monitoring, dietary guidance, and follow-up evaluations.
➤ Medical tourism support: Translation, travel arrangements, and continuity of care for international patients.
✅ Highlights:
✔ POEM is a minimally invasive treatment for achalasia
➔ Relieves dysphagia and regurgitation rapidly
● Short recovery with hospital stay of 1–2 days
★ Risks include perforation, bleeding, infection, or reflux
➤ Korean hospitals offer cutting-edge endoscopic expertise with high success rates
