Wednesday, May 13, 2015

Thoracic surgeons at University of Iowa Heart and Vascular Center report achieving excellent outcomes for achalasia patients who have received an innovative therapy, the per-oral endoscopic myotomy, or POEM procedure. One of the most difficult to treat and rarest of the esophageal motility disorders, achalasia is distinguished by abnormal peristalsis and incomplete relaxation of the lower esophageal sphincter, resulting in progressive dysphagia and regurgitation.

POEM Procedure

As the disorder is not curable, the goal of treatment is symptom improvement. Primary treatment for achalasia had been limited to large-diameter balloon pneumatic dilation, invasive abdominal (laparoscopic Heller Myotomy) or thoracic surgical approaches that require complete mobilization of the gastroesophageal junction, and often, adjunctive anti-reflux surgical repair.

With the totally endoscopic POEM procedure, the treatment objective is the same; division of the circular muscle fibers and lower esophageal sphincter. The repair, however, is approached transorally, through the esophageal mucosa by creation of submucosal tunnels.

POEM is associated with:

• Less blood loss
• Equivalent or shorter operative time
• Less or no pain
• Earlier return to work.

Patients appropriate for this procedure have symptomatic achalasia and a diagnosis confirmed by manometry and upper endoscopy. Exclusion criteria include patients with: known coagulopathies, severe pulmonary disease, cirrhosis with portal hypertension, previous esophageal surgery, prior interventions resulting in significant submucosal fibrosis such as esophageal irradiation, esophageal ablation therapy, or endoscopic mucosal resections.

“The results we have achieved with the POEM procedure have been excellent,” says John Keech, MD, UI thoracic surgeon. “We have an average length of stay of less than 24 hours, and of the 19 cases we have performed to date, 16 report complete symptom relief. This is equivalent to our success with laparoscopic Heller Myotomy. There have been no mortalities or major adverse events.”

A technically demanding procedure, POEM requires a unique set of skills that combine the expertise of interventional gastroenterologists (Henning Gerke, MD at UIHC), and thoracic surgeons to provide the highest level of care. The University of Iowa Hospitals and Clinics is the only institution in Iowa performing the procedure.

For questions about the POEM procedure, or to refer a patient, please call: 319-353-6420, or email Dr. Keech at John-Keech@uiowa.edu.