POEM: Endoscopic treatment of Achalasia
Achalasia is a disease of the esophagus characterized by difficulty passing food from the esophagus to the stomach. This happens as a consequence of altered function of the lower esophageal sphincter, a muscle that acts as a valve between the two organs and, in cases with achalasia, has difficulty relaxing properly. Individuals with achalasia have a an increasingly difficult time passing food and experience regurgitation, vomit, frequent burps, and bad breath due to the food breaking down within the esophagus. The consequences include progressive weight loss that can affect the social and laboral life of the individual. The diagnosis of achalasia is done through endoscopy and is confirmed by esophageal manometry.
Until very recently, the treatment of achalasia was done through an open surgery where the muscle fibers of the esophageal sphincter were sliced. Laparoscopic surgery techniques were later developed. Both methods, however, require a simultaneous anti-reflux surgery to avoid the return of food from the stomach to the esophagus.
Currently, the most modern and minimally invasive treatment is done endoscopically, without the need for open surgery. This requires a method called per oral endoscopic myotomy, or POEM, in which an incision is made in the upper esophagus to create a tunnel within the layers of the esophagus underneath the mucosa along the length of the tract until the junction of the esophagus and stomach is reached. Once here, the muscle fibers of the junction are sectioned until the sphincter is sliced. Lastly, the incision is closed by means of special staples called hemoclips. Everything is done endoscopically. The day following the procedure, a radiographic study is performed to confirm the appropriate passing of contrast into the stomach and the patient may begin drinking liquids.
This modern endoscopic treatment must be performed at a hospital that has a variety of important instruments at its disposal. These include a CO2 insufflator, a sophisticated unit for injection of solution and electrocoagulation called ERBEJet, and a wide variety of endoscopic Knifes that allow the completion of the myotomy without the need of open surgery.
In our city of Reynosa, the Surgery and Gastroenterological Endoscopy Center jointly with the Santander Hospital are prepared with the experience and equipment to successfully treat achalasia by means of endoscopic surgery.
Dr. Carames has been trained directly by Dr. Inoue, the creator of this endoscopic surgery technique.