POEM Procedure: A Minimally Invasive Treatment for Achalasia

Like breathing, swallowing is something we do automatically, whether we’re awake, asleep, eating, drinking—or taking a big gulp to summon some courage.

Swallowing usually happens naturally. But that doesn’t mean it’s simple—or that things can’t sometimes go wrong. In fact, swallowing, explains Harry Aslanian, MD, a Yale Medicine gastroenterologist, is a highly complex maneuver—particularly when it comes to eating and drinking.

“There are many motions and muscles that are involved in coordinating the initial swallow to get the food into the esophagus and bypass the windpipe,” he says.

From there, the sphincter at the upper end of the esophagus has to open and the food needs to be transported to the stomach, which calls on the intestinal tract muscles to squeeze the food along.

But for people with a disorder called achalasia, the lower esophageal sphincter does not relax and allow food to pass into the stomach, as it should. In addition, the muscles that normally contract to push the food along do not.

“The combination of both of these abnormalities results in food getting stuck in the esophagus,” says Anil Nagar, MD, a Yale Medicine gastroenterologist.

Although some medications and surgery can help with achalasia, there is no cure. But now there is an endoscopic procedure called POEM (peroral endoscopic myotomy) that has proven to be highly effective at treating achalasia, and it doesn’t require making any surgical incisions in the abdomen.

A patient is placed under general anesthesia and an endoscope, or a thin tube with a camera and surgical instruments, is inserted into the mouth. When the endoscope reaches the lower esophagus, the surgeon makes small incisions in the esophageal muscles and the upper stomach, which relaxes the muscles and allows food to reach the stomach.

In this video, Drs. Aslanian and Nagar talk more about the benefits of POEM and how it is now being used to treat other esophageal disorders.