Achalasia in brief
The main signs are food sticking in the chest, bringing back undigested food (especially when lying down), chest pain and weight loss. It's often mistaken for acidity for years. The diagnosis is made with endoscopy, a barium swallow and oesophageal manometry (a pressure test of the food pipe).
How POEM is done
- Under general anaesthesia, a small opening is made in the inner lining of the food pipe.
- A tunnel is created within the wall, down to and just past the valve.
- The tight inner muscle layer is carefully divided.
- The opening is closed with clips.
It usually takes 1–2 hours. Most people stay in hospital for 1–3 days, starting with liquids and moving to a soft diet.
How well does it work?
In published studies, POEM relieves swallowing difficulty in about 9 out of 10 people in the first years, results comparable to surgical (Heller) myotomy. Results for any individual depend on the type of achalasia and other factors, which we'll discuss.
Reflux after POEM
Because POEM doesn't add an anti-reflux wrap, acid reflux is common afterwards. It's usually well controlled with medicines. We check for it at follow-up.
Comparing the options
| Option | Key points |
|---|---|
| POEM | No skin incisions; length of the cut can be tailored; reflux more common |
| Pneumatic balloon dilatation | Outpatient; may need repeating over time |
| Laparoscopic Heller myotomy + fundoplication | Keyhole surgery; less reflux; abdominal incisions |
| Botox injection | Short-lived; for people not fit for other options |
Risks
Serious complications are uncommon in experienced hands. They include bleeding, a leak or perforation, and air collecting under the skin or in the chest, usually managed without surgery. Reflux is the most common long-term issue.