Having surgery

POEM surgery for achalasia

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

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 have POEM surgery under general anaesthetic.

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

Pre-assessment

You attend a pre-assessment appointment in the outpatient clinic.

It's important that you are on a liquid-only diet for 3 days before surgery to make sure that your food pipe is empty. 

The surgeon may still want to do a gastroscopy and wash out your oesophagus on the day of surgery. 

During surgery

Surgery is done under general anaesthetic and takes about 2 hours.

We pass a thin, flexible tube (endoscope) through your mouth.

We make a small cut in the lining of the oesophagus. We carefully divide the lower oesophageal sphincter muscle fibres. The cut is then closed.

The surgery is done inside the oesophagus so you will not have a visible cut (incision) or wound. 

After surgery

You stay in the recovery room until you are comfortable and fully awake. 

Carbon dioxide gas is used during surgery to inflate the oesophagus. This means you might feel bloated or feel pain in your chest, neck and tummy. The carbon dioxide and any pain will be gone within a few hours. 

We give you painkillers during and after surgery but let us know if you are uncomfortable.

We move you to a hospital bed where we regularly check your pulse, blood pressure, temperature and breathing. 

We encourage you to drink sips of water and to get out of bed and move about. 

The next day, you have an X-ray to check that your incision is sealed. If we are satisfied with the X-ray results, you will be able to drink tea or other beverages. 

You  usually stay in hospital for 1 or 2 nights. However, if there are any complications you will need to stay in hospital until these have been resolved. 

Recovery

We ask you to follow a free-fluid diet for the first week. After that you can start eating normal food again.

We give you painkillers when you are discharged from hospital. It is unlikely that you will need strong painkillers after 1 to 2 days.

You should take 2 weeks off work to recover. If you are well at this point, you can go back to all your normal activities.  

Contact your GP or go to your nearest A&E if:

  • you have a high temperature of 38C or above (fever)
  • chest pain that's getting worse

Follow-up appointment

We make a follow-up appointment with the surgeon or clinical nurse specialist for about 6 weeks after you were discharged.

At this appointment, we check if the surgery has been successful and if any reflux symptoms have developed. If surgery has not improved your swallowing, we can talk about if other treatments options might help you. 

There are no stitches to be removed.

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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