POEM surgery for achalasia (difficulty swallowing)
Achalasia is a lifelong condition when the muscles in your food pipe (the oesophagus) do not work properly. This makes it difficult to swallow food and drink.
If you have achalasia, the ring of muscle (sphincter) in your food pipe is tight and does not relax. Food and drink cannot pass into the stomach and they build up. This can cause:
- acid reflux (when stomach acid flows up into the food pipe)
- a feeling of fullness
- other symptoms
POEM (peroral endoscopic myotomy) is surgery to help your symptoms and improve swallowing.
You can read more about achalasia on the NHS website.
How POEM surgery can help
Achalasia is a lifelong condition and swallowing usually gets more difficult with time. POEM surgery can help your symptoms and improve swallowing by allowing the food pipe to empty.
You have POEM surgery under general anaesthetic. This is a medicine that makes you sleep during the procedure and stops you feeling anything.
During the surgery, we cut the muscle fibres in the ring of muscle that lets food and drink into your stomach. They are called the lower oesophageal sphincter muscle fibres.
The ring of muscle separates your food pipe from the stomach. It acts like a valve to stop food and drink from moving back up into the food pipe (reflux).
You are likely to stay in hospital for 1 or 2 nights.
There are risks with any surgery. Specific risks for POEM surgery include:
- bleeding and tearing of the food pipe (oesophageal perforation). You may need more surgery to repair any hole in the food pipe
- a chest infection
- swallowing problems that continue or return after the surgery
- acid reflux. Cutting the ring of muscle may cause stomach acid to travel back up into your food pipe. You can usually control reflux symptoms by taking anti-acid tablets. In the long term, about 3 out of 10 people need medicines for reflux symptoms
Other treatment options
Some people prefer to follow a soft diet rather than have surgery. However, this may make future treatment difficult because the food pipe gradually stretches with time.
Heller’s Myotomy and fundoplication
This procedure can make swallowing easier permanently. You have keyhole (minimally invasive or laparoscopic) surgery under general anaesthetic.
There are 2 stages to the surgery.
- We cut the lower oesophageal sphincter muscle fibres. This involves making 4 or 5 small cuts (incisions) on your tummy.
- We then stitch a flap of stomach over your food pipe. This process is called fundoplication. It significantly reduces acid reflux in the long term.
Stretching the ring of muscle (pneumatic or balloon dilation)
You have this procedure under sedation (a medicine to make you feel calm and sleepy).
The aim of the procedure is to stretch the lower oesophageal sphincter muscle fibres. We pass a hollow tube with a balloon at the end down your food pipe. Then, we inflate the balloon. The lower oesophageal sphincter muscle fibres are slightly overstretched until they break.
This procedure often needs to be repeated until the desired number of muscle fibres break and your swallowing improves.
A botox injection can give you temporary relief from swallowing problems. However, the injection needs to be repeated and is not a long-term solution. For this reason, we do not often recommend this procedure.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have surgery, we ask you to sign a consent form. This says that you agree to have the treatment and understand what it involves.
If you would like more information about our consent process, please speak to a member of staff caring for you.
Resource number: 4853/VER2
Last reviewed: June 2022
Next review: June 2025