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Swallowing Difficulty Treatment: POEM
Sometimes muscle problems in the esophagus can lead to difficulty swallowing. Rare diseases such as achalasia in particular can negatively affect a person's quality of life. Early diagnosis and treatment of such problems are important to prevent more serious health problems from developing. One of the most commonly used treatment methods for swallowing problems is the POEM procedure. For more comprehensive answers to questions such as “What is the POEM procedure and how is it performed?”, you may continue reading.
What Is POEM?
Peroral endoscopic myotomy (POEM) is a surgical procedure used in the treatment of digestive system diseases. POEM is used especially to treat muscle problems in the esophagus, the tube located between the mouth and the stomach. Achalasia or other swallowing problems generally arise from the relaxation of the muscles in the esophagus and the lower esophageal sphincter below it. This condition makes swallowing difficult and may make it harder for food to reach the stomach. However, this problem can be easily treated with the POEM procedure.
Because the POEM procedure is less invasive than traditional surgery, the recovery process may be faster. Patients can usually return to their normal diet after a short time. However, as with every surgical procedure, POEM also carries risks, and complications may occur.
Which Diseases Is the POEM Procedure Used For?
The peroral endoscopic myotomy (POEM) procedure can be used to treat the following digestive system diseases.
Excessive esophageal contractions (Achalasia): Achalasia is a condition in which the muscles in the lower part of the esophagus cannot relax normally. The POEM procedure is effective in treating achalasia by cutting the muscle layer in the lower part of the esophagus, allowing it to relax.
Diffuse esophageal spasm: Diffuse esophageal spasm is a motility disorder that causes irregular and excessive contractions of the esophagus. The POEM procedure can be used to reduce these contractions and relieve symptoms.
Compression of the esophagus (Esophageal stricture): Esophageal stricture is a condition in which narrowings form within the esophagus. The POEM procedure can be used to open the stricture and allow the esophagus to perform its normal function.
The POEM procedure is a method proven to be effective in treating the conditions mentioned above. However, since each patient's condition may differ, decisions regarding treatment options and the application of POEM should be made by a physician after a detailed evaluation.
How Is POEM Treatment Performed?
The POEM procedure is generally performed under general anesthesia. An appropriate anesthesia method is selected by the anesthesiologist to keep the patient comfortable and ensure the procedure is performed painlessly. During the procedure, an endoscope (a flexible tube) is inserted through the patient's mouth and advanced to the esophagus. An endoscope is a device with a camera at its tip that allows the physician to view images of the esophagus. Then, an incision is made in the inner layer of the esophagus using endoscopic instruments. This incision is one of the main steps of the POEM procedure and provides access to the muscle layer of the esophagus.
Once the muscle layer is reached, the muscle layer in the lower part of the esophagus is cut using endoscopic instruments. As a result, the irregular contractions of the esophagus decrease. After the muscle cutting is completed, the incision usually heals on its own. Additional surgical steps such as sutures or staples are generally not required. The POEM procedure is a minimally invasive (performed with the fewest possible incisions) procedure and generally does not require a hospital stay of several days. The healing process may vary from person to person, but patients often return to their normal diet within a few days.
How Does the POEM Procedure Differ from Other Treatment Methods?
The POEM procedure has some features that differ from other treatment methods:
Minimal invasiveness: The POEM procedure is a less invasive approach compared with open surgery. The procedure is performed endoscopically, meaning it does not require large external incisions or open surgery. Therefore, the POEM procedure generally carries a lower risk of complications, is less painful, and provides a rapid recovery process.
Cutting of the muscle layer: The POEM procedure relaxes the esophagus by cutting the muscle layer in its lower part. In other methods, mechanical manipulations such as dilation or balloon dilation are generally applied to the muscles in the lower part of the esophagus. In the POEM procedure, cutting the muscle layer more effectively reduces the irregular contractions of the esophagus, helping to bring symptoms under control.
Long-term effectiveness: The POEM procedure is a treatment option whose long-term effectiveness for esophageal motility disorders has been proven. It has been shown that POEM is more effective than other methods in relieving symptoms and controlling the disease, especially in conditions such as achalasia.
Possibility of personalized treatment: The POEM procedure allows treatment to be personalized. During endoscopy, the physician can adjust the location of the incision, the size of the muscle cut, and other details according to the patient's condition and needs.
Frequently Asked Questions
Difficulty swallowing is a health problem that can occur at any age. However, it can be brought under control when the necessary precautions are taken. Frequently asked questions about difficulty swallowing and their answers are provided below.
Can the POEM Procedure Be Applied to Every Case of Swallowing Difficulty?
The POEM procedure cannot be applied to every case of swallowing difficulty. POEM is a method used to treat specific conditions related to esophageal motility disorders.
Can Swallowing Difficulty Be Treated with Medication?
Although some cases of swallowing difficulty can be treated with medication, medication may not be suitable for every condition that causes swallowing difficulty. Medications are generally used to treat the underlying cause or to relieve symptoms. For example, in the treatment of acid reflux, one of the diseases that can cause swallowing difficulty, medications that reduce stomach acid levels may be used. Also, since esophagitis (inflammation of the esophagus) can cause swallowing difficulty as well, antibiotics or medications that reduce acid levels may be used in the treatment of esophagitis.
In some cases, excessive contractions of the muscles in the lower part of the esophagus may cause swallowing difficulty. In such cases, muscle relaxant medications may be used. These medications may help make swallowing easier by allowing the esophageal muscles to work more comfortably. However, medication treatment may not always be effective, and in some cases surgery or other treatment methods may be needed. A person experiencing swallowing difficulty should be evaluated by a gastroenterologist, and appropriate treatment options should be determined.
Which Diseases Can Cause Swallowing Difficulty?
Swallowing difficulties may be a symptom of various diseases. Some common diseases that can cause swallowing difficulty are listed below:
Esophageal stricture: Esophageal stricture is a condition in which the esophagus narrows or becomes blocked. This condition may result from factors such as esophageal cancer, Barrett's esophagus, esophagitis, or scar tissue. Esophageal stricture causes swallowing difficulty because the passage of food becomes difficult.
Achalasia: Achalasia is a condition in which the muscles in the lower part of the esophagus cannot relax normally. This condition may cause symptoms such as difficulty swallowing, chest pain, and regurgitation (the backflow of food).
Scleroderma: Scleroderma is an autoimmune disease in which connective tissue becomes excessively hardened. If the muscles in the lower part of the esophagus are affected by the disease, difficulty swallowing may occur.
Gastroesophageal reflux disease (GERD): GERD is a condition in which stomach acid flows back into the esophagus.
Neuromuscular diseases: Some neuromuscular diseases may affect the normal functions of the esophageal muscles, which can lead to difficulty swallowing. For example, diseases such as cerebral palsy, multiple sclerosis, and myasthenia gravis may cause swallowing difficulty.
Other conditions that may cause swallowing difficulty include esophageal tumors, inflammation of the esophagus, the presence of foreign bodies, and weakness of the swallowing muscles.
What Is the Success Rate of POEM?
POEM is accepted as an effective and proven method for the treatment of esophageal motility disorders. Research and clinical experience with the POEM procedure show that its success rate is high. In particular, POEM can provide long-term success in the treatment of swallowing disorders such as achalasia. Studies show that the POEM procedure has higher success rates than other treatment options in relieving achalasia symptoms and controlling the disease. However, the success rate of the POEM method may vary depending on the type of disease, the patient's characteristics, and the surgeon's experience.
Are There Complication Risks During and After the POEM Procedure ?
There are some complication risks during and after the POEM procedure. These risks can be listed as follows:
Bleeding: Because an incision is made in the inner layer of the esophagus during the POEM procedure, there is a risk of bleeding. In most cases the bleeding is mild and stops on its own. However, in rare cases serious bleeding may occur and additional intervention may be required.
Infection: There is a risk of infection after the POEM procedure. Therefore, it is important to pay attention to hygiene measures before and after the procedure. If signs of infection (fever, redness, swelling) appear, a doctor should be consulted immediately.
Esophageal perforation: During the POEM procedure, while the inner layer of the esophagus is being incised, perforation of the esophagus (a tear through the wall) may rarely occur. This is a serious complication and requires urgent intervention.
Reflux: After POEM treatment, gastroesophageal reflux (the backflow of stomach contents into the esophagus) may develop in some patients. If reflux symptoms (burning sensation, acid reflux) appear, a physician should be consulted and appropriate treatment methods should be evaluated.
Transient dysphagia: After the POEM procedure, temporary difficulty swallowing (dysphagia) may occur. However, this condition usually resolves within a few days.
Inflammation and esophagitis: After the POEM procedure, temporary inflammation or esophagitis may develop in the esophagus. In this case, the physician may recommend appropriate treatment methods to relieve symptoms and ensure recovery.
Is Hospitalization Required for POEM?
The POEM procedure is generally a treatment method performed in a hospital. Depending on the risk of complications and the patient's general health condition, the patient may stay in the hospital for several days after the procedure. If you are experiencing difficulty swallowing, do not neglect to apply to the nearest healthcare facility for early diagnosis and treatment.
