Overview

POEM surgery for achalasia

Achalasia is a life-long condition when the muscles in the oesophagus (food pipe) do not work properly. This makes it difficult to swallow food and drink. 

In achalasia, the ring of muscles in the oesophagus is tight and does not relax. Food and drink cannot pass into the stomach and builds up. This can cause pain, reflux, a feeling of fullness and 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 life-long condition and swallowing usually becomes more difficult over time.

POEM can help your symptoms and improve swallowing by allowing the oesophagus to empty. 

POEM is surgery done under general anaesthetic. We cut the lower oesophageal sphincter muscle fibres. This muscle separates the oesophagus from the stomach and acts like a valve to stop food and drink from backing up (reflux).

You are likely to stay in hospital for 1 or 2 nights. 

Read more about having POEM surgery for achalasia.

Risks

There are risks with any surgery. Specific risks for POEM include:

  • bleeding and tearing of the food pipe (oesophageal perforation) which may require further surgery to repair 
  • chest infection 
  • difficulty swallowing will continue or return after the operation 
  • cutting the muscle results in gastric acid being brought back up (reflux). Reflux symptoms can usually be controlled with anti-acid tablets. In the long term, about 30 out of 100 people will need medicines for reflux symptoms

Other treatment options

Diet

Some people prefer to follow a soft diet rather than have surgery. However, this may make future treatment difficult as the oesophagus will gradually stretch over time.  

Heller’s Myotomy and fundoplication

This procedure can make swallowing easier permanently and is carried out using keyhole surgery (laparoscopic) under general anaesthetic.   

We make 4 or 5 small incisions (cuts) on your tummy to cut the lower oesophageal sphincter muscle fibres. A flap of stomach is stitched over the oesophagus (this is called fundoplication). This significantly reduces reflux in the long term. 

Pneumatic or balloon dilation

This procedure is done under sedation to stretch the lower oesophageal sphincter muscle fibres. A hollow tube with a balloon at the end is passed down the oesophagus. We inflate the balloon and the lower oesophageal sphincter muscle fibres are slightly over-stretched until they break. This procedure often needs to be repeated until the desired number of muscle fibres are broken and swallowing is improved. 

Botox injection

A botox injection can provide temporary relief of swallowing but it has to be repeated. It is not a long-term solution and therefore not often recommended. 

We want to involve you in decisions about your care and treatment. If you decide to have surgery, you will be asked to sign a consent form. This states that you agree to have the treatment and you 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

Contact us

If you have any questions or concerns about POEM, contact the benign upper GI clinical nurse specialist.

Phone: 020 7188 2673 Monday to Friday, 9am to 5pm.

You can also phone the surgeon’s secretary on 020 7188 6475

Out of hours, please call the hospital switchboard on 020 7188 7188 and ask for the bleep desk. Ask for bleep 0810 and wait for a response. You will be connected to the surgical registrar on call.

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Contact our Patient Advice and Liaison Service (PALS)

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