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Peroral Endoscopic Myotomy (POEM)

POEM is a therapeutic endoscopic procedure performed in the endoscopy unit at our hospital. Our doctors use high-definition upper endoscopes to perform the procedure. POEM takes approximately two to three hours, and you are expected to stay in the hospital for an average of two days for monitoring and to receive intravenous antibiotics.

POEM: Why It’s Performed

Our doctors perform POEM to treat the following disease:

  • Achalasia
  • Spastic esophageal disorders not responding to medical therapies (e.g., diffuse esophageal spam, nutcracker esophagus)

Cutting Edge Cure for Achalasia - POEM Procedure

The same determination that makes Chris a competitive triathlete, drove him to research treatment options for his rare digestive disorder - achalasia. His search for solutions brought him to Dr. Mouen Khashab of Johns Hopkins Hospital who is performing a pioneering endoscopic procedure.

POEM: What to Expect

Before your procedure, you will need to follow specific preparation instructions. Your doctor will discuss them with you in detail. Preparation instructions are as follows:

  • You may only have a liquid diet for two days prior to the procedure.
  • You may not eat or drink for 12 hours prior to your procedure. This ensures that your esophagus is clear of food products.
  • Tell your doctors if you have any allergies.
  • Your doctor will instruct you regarding any prescription medication you take.

On the day of the procedure, arrive three hours before your POEM is scheduled to start. When you arrive, you will register and give your medical history.

During POEM:

  1. We will insert an IV into your vein in order to administer fluids, anesthesia and antibiotics.
  2. We will insert an arterial line to monitor your pressure during the procedure.
  3. Your doctor will pass the endoscope through your mouth and into the esophagus where the therapy will be applied.
  4. Your doctor observes the images on a nearby monitor.
  5. There won’t be any incisions or cuts outside your gastrointestinal tract.
  6. An initial incision will be made in the internal lining of the esophagus. This permits entry of the endoscope to within the wall of the esophagus, where the muscle will be exposed.
  7. The inner layer of the muscle near the lower esophageal sphincter will be cut (this is termed myotomy).
  8. At the conclusion of the procedure, the esophageal incision will be closed with standard endoscopic clips.

Once the procedure is finished, you will need to recover from the anesthesia in the endoscopy unit. Your doctor will discuss the procedure with you. Then you will be admitted to the hospital for monitoring and antibiotics. You will keep fasting on the night of the procedure.

You will receive an X-ray (barium swallow) the following morning and you will be permitted to drink liquids if the test comes back OK. You will advance to a soft diet the following day and will be discharged afterward.

POEM: How It's Performed

Peroral Endoscopic Myotomy (POEM) | Q&A

Mouen Khashab, MD, Assistant Professor of Medicine and Director of Therapeutic Endoscopy, Johns Hopkins Gastroenterology & Hepatology, discusses Peroral Endoscopic Myotomy (POEM) - how it is performed, who is eligible for the procedure, expected outcomes and the key benefits.