It is normal to feel a lump in your throat when you eat. But if you constantly have difficulty swallowing food and feel like it is stuck in your chest, then this is not normal. This could be due to a problem with the muscles in your esophagus. Today we are going to talk about a special and very effective treatment for such cases.
What is POEM?
You may be surprised to hear the name POEM. It stands for Oral Endoscopic Myotomy . Let's explain it simply.
- Peroral: means "through the mouth."
- Endoscopic: refers to something done using a flexible, camera-equipped tube called an endoscope.
- Myotomy: The medical term for "muscle cutting."
Simply put, POEM is a procedure that involves inserting an endoscope through your mouth, without making any cuts in your skin, and cutting and relaxing the tight muscles in your esophagus. It's like surgery, but since there are no incisions on the outside of your body, the recovery time is much shorter.
Who needs this treatment?
This treatment is mainly used for people with esophageal motility disorders such as achalasia . In these conditions, the muscles in the lower part of the esophagus do not relax properly. Then, when you swallow food, the food gets stuck in the esophagus instead of going down to the stomach. This can cause difficulty swallowing, chest pain, and food coming back up into the throat. POEM treatment works by relaxing those tight muscles, allowing food to pass through to the stomach without any obstruction.
How do you prepare before POEM treatment?
You need to do some preparation before this treatment. But don't worry about it. Your doctor will give you clear instructions on everything. The most important thing is to follow those instructions exactly.
These are the things you usually do:
- You will need to eat only a clear liquid diet for two days before the treatment.
- You must completely stop eating and drinking 12 hours before the treatment.
Remember, following these instructions exactly is very important for the success of the treatment.
What happens during treatment?
This procedure takes about one to three hours. During this time, you will be given general anesthesia, so you will be completely asleep. Therefore, you will not feel any pain. Let's take a step-by-step look at how the treatment is performed.
| Steps | What is happening? |
|---|---|
| 1. Inserting the endoscope | The doctor will insert an endoscope through your mouth and down your esophagus. The camera on it allows you to see the inside of your esophagus. |
| 2. Applying a cut to the mucous membrane | The lining of the esophagus, the mucosa, is cut into small pieces. |
| 3. Making a tunnel | The endoscope is inserted through that incision and travels down a tunnel-like path along the submucosa, a layer of tissue above the muscle layer. |
| 4. Muscle cutting (Myotomy) | Going down, the problem area, that is, the tight muscles in the lower part of the esophagus and the upper part of the stomach, are cut and loosened with a small knife attached to the endoscope. |
| 5. Closing the incision | Finally, the incision made in the mucosa is closed with a few small clips. Then the endoscope is removed. |
What happens after treatment and how long does it take to recover?
After the treatment, you will need to stay in the hospital for about a day. This will be to check for any complications. Your recovery period will begin the next day.
- Test: A barium X-ray is done to see if the muscles are properly relaxed and the passage for food is clear.
- Food: You will need to eat liquid foods for the first two to three days. After that, you should get used to eating soft, low-fiber foods for a week or two.
- Returning to work: You can return to work in about seven days. However, if you are doing a job that involves heavy lifting or strenuous work, it is best to ask your doctor about the best day to return to work.
- Follow-up: Your doctor will ask you to come back 10 days after treatment and again 3 months later. During the 3-month test (esophagram), they will also check to see if your esophagus is emptying properly after you swallow.
When to see a doctor immediately
Complications from POEM treatment are very rare . However, if you experience any of the symptoms below after treatment, you should contact your doctor immediately.
| Warning signs |
|---|
| - Severe chest pain |
| - Coughing up blood |
| - Fever (38.3°C Celsius / 101°F Fahrenheit or higher) |
| - Extreme fatigue, fainting |
| - Black or red stools |
| - Severe pain in the throat |
If you have any of these symptoms, don't delay. See your doctor as soon as possible. If necessary, go to the Emergency Department (ETU) of the nearest hospital.
Take-Home Message
- POEM is a highly effective, modern treatment for swallowing disorders such as achalasia.
- This is done using an endoscope inserted through the mouth, so no incisions are made on the outside of the body.
- According to research, this treatment successfully eliminates swallowing difficulties in about 95 out of 100 people.
- Although the recovery period is short, it is imperative to follow the doctor's instructions regarding diet and activity exactly after treatment.
- If any warning signs appear after treatment, inform your doctor immediately.
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