PerOral Endoscopic Myotomy holds promise for patients with esophageal achalasia

Northwestern Memorial HospitalAug 24 2011

POEM is one of a growing number of surgeries to use the body's natural orifices for entry

Jorge Sobenes is a husband and father who loves to cook for his family. In a nine month period however, he went from enjoying his favorite foods to not being able to eat or drink due to a tightening in his throat and difficulty swallowing. He lost 40 pounds and was desperate for answers. Sobenes was diagnosed with achalasia, a condition where the esophagus is unable to move food into the stomach, and was told he would need surgery. Historically, the procedure requires several incisions in the abdomen in order to access the blocked esophageal pathway. Sobenes however was able to undergo surgery without any external incisions thanks to an innovative new research approach called PerOral Endoscopic Myotomy (POEM). The procedure is one of a growing number of surgeries to use the body's natural orifices as an entry point, thus eliminating the need for traditional incisions. Northwestern Memorial Hospital is one of only a few centers in the U.S. with surgeons trained to perform the procedure.

"This surgical approach not only eliminates the need for external incisions, but also offers greater precision and a faster healing time for patients," said Eric Hungness, MD, gastrointestinal surgeon at Northwestern Memorial.

POEM is performed by inserting an endoscope in the mouth and tunneling it down the esophagus so surgeons can access and cut abnormal muscle fibers that prevent the valve at the base of the esophagus from opening to allow food to enter the stomach. It is currently under investigation and is being offered as part of a clinical trial at Northwestern Memorial.

Sobenes, who was one of the first patients in the country to be treated for achalasia using the investigational procedure, said the choice was easy for him. "What I was going through was terrible. I couldn't eat. I couldn't drink. I wanted to get back to normal as fast as possible and was happy to hear of this alternative," said Sobenes.

More than 3,000 people are diagnosed with esophageal achalasia each year. The most common symptom is difficulty eating solid food and drinking liquids. As it advances, achalasia can cause considerable weight loss and malnutrition. Common treatments for esophageal achalasia include a traditional surgical approach known as a Heller myotomy, or balloon dilation.

"Previously, we had to make at least five incisions in a patients abdomen in order treat esophageal achalasia surgically," said Hungness. "Although the research continues and final results are not known, POEM is an exciting idea that holds great promise for patients and demonstrates the bright future for incisionless surgeries."

Approximately 150 POEM procedures have been performed in the world since 2008. Hungness, together with Nathanial Soper, MD, chair of surgery at Northwestern Memorial, have been among those pioneering Natural Orifice Translumenal Endoscopic Surgery (NOTES). The team was the second in the country to perform a gallbladder removal through the mouth in 2007, and has since removed a gallbladder through the vagina as well.

Doctors stress that treatment options must be carefully selected based on the unique needs of the patient, but say minimally invasive procedures such as POEM have been shown to offer an array of potential benefits including greater surgical precision, a shorter recovery time, shorter hospital stay, less pain and in the case of POEM, a lower incidence of reflux post procedure.

"This is the future of surgery," said Soper. "With each new procedure, we learn how to apply the technique and technology to other surgeries and develop new tools."