A Journey to Relief: Understanding POEM for Achalasia

Imagine having to fight a battle every time you take a meal or a sip of water. This has been the story of Rajesh, 45 years old, from Jaipur, where he has been suffering from achalasia for years now. Achalasia is a rare disorder of the lower esophageal sphincter, the valve between the esophagus and stomach. Generally, the two rings of muscles in this part relax to allow swallowing, but for patients with achalasia, it's hard or even impossible to swallow food and liquids into the stomach easily.

Time went by and frustration began to creep into Rajesh. Nothing seemed to last long and several treatments could hardly provide any pain relief. Then, Rajesh discovered the Institute of Gastroenterology and Digestive Health (IGDH) at Marengo Asia Hospitals in Gurugram, a centre of excellence for state-of-the-art gastrointestinal treatments. It was here that he discovered a minimally invasive procedure called Per-Oral Endoscopic Myotomy (POEM).

Rajesh’s Search for Relief

Rajesh's journey began with a visit to Marengo Asia Hospitals, the best in digestive health and the latest treatment options. His condition of achalasia has been worsening over time-leading to difficulty in swallowing, chest pain, and regurgitation of undigested food. The hope finally came after consulting one of the expert gastroenterologists at Marengo Asia Hospitals.

Doctors at Marengo Asia Hospitals explained in detail his condition after subjecting him to a rigorous diagnostic investigation. Achalasia occurs due to damage to the nerves in the esophagus, which leads to the inability of the LES to relax. This results in a buildup of food in the esophagus, causing discomfort, difficulty in swallowing (dysphagia), and the feeling of food sticking up in the throat.

“When my doctor explained POEM to me, I was curiously worried," says Rajesh. "The concept of rectifying my condition without any kind of cut on the outside seemed like a breakthrough."

Understanding POEM: A Game-Changer for Achalasia

POEM, or Per-Oral Endoscopic Myotomy, is an advanced procedure intended to cure achalasia by attacking the root problem: tight muscles on the lower end of the esophagus. The entire procedure is carried out using an endoscope through a series of endoscopic manipulations performed entirely from within the esophagus without any such breakage of tissue on the abdominal wall. It tries to loosen the stiff muscles of the LES so that it opens normally and lets food pass into the stomach. As a minimally invasive procedure, POEM provides quicker recovery time.

The Day of Rajesh’s Procedure

On the day of the POEM procedure, Rajesh arrived at Marengo Asia Hospitals' advanced facility in Gurugram accompanied by his family. The team put him through strict physical and mental preparations before the surgery.

"Everyone at the hospital was so reassuring. They explained the procedure step by step, and it made me feel more at ease," says Rajesh.

What Happens During a POEM Procedure?

Here’s what happens during the POEM procedure:

1. Anesthesia and Preparation:

Once Rajesh was taken into the operating room, he was administered with general anaesthesia through an intravenous line. This ensured that he was sound asleep and comfortable all through the process. General anaesthesia is crucial since it makes it possible for the surgical team to carry out the procedure with ease and in a painless fashion as Rajesh would be completely unaware of what is happening. The anaesthesia also ensured that the muscles of the esophagus were relaxed for the best outcome possible.

2. Endoscope Insertion:

Now, once Rajesh was fully anaesthetised, the surgeon inserted an endoscope-a soft flexible tube with a camera at the end into his mouth. The soft tube slid easily down into the esophagus through his throat. Live video feed was transmitted through the camera to a monitor so that the surgeon could see inside the wall of the esophagus and then guide the next steps gently.

3. Creating the Submucosal Tunnel:

Using the endoscope, the surgeon made a small incision in the innermost layer of the esophagus (the mucosa) to create what’s known as a submucosal tunnel. This tunnel runs between the inner mucosal layer and the muscle layer beneath it. The creation of this tunnel is a critical step, as it allows the surgeon to safely access the muscle layer without damaging the esophagus's outer lining. The tunnel also provides a protected pathway for the next part of the procedure—the myotomy.

4. Performing the Myotomy:

With the tunnel now created, the surgeon proceeded to use a specialised cutting tool attached to the endoscope to perform the myotomy-the cutting of the constricted muscle fibres in the lower esophageal sphincter. The close-cutting of these tight muscles removed the obstruction that had barred food and liquids from reaching Rajesh's stomach. The myotomy therefore opened up the sphincter, and food and liquids can thus pass smoothly from the esophagus to the stomach.

5. Securing the Area:

After the myotomy, the surgeon applied endoscopic clips on the mucosal incision site to stabilise the area. This has ensured that the opening left after the procedure was closed off and healed well without much leakage or infection as the submucosal tunnel heals.

6. Completion and Recovery:

Once the muscle cutting and tying were done, the surgeon slowly pulled out the endoscope through Rajesh's mouth. The procedure was now over. Rajesh was transferred to a recovery room where he was to slowly recover from the anaesthetic effects. The recovery team kept track of his vital signs and made sure that he came around pain-free and without complications.

The First Steps of Recovery

"When I woke up, I was relieved," he says. "I was still sleepy, but I knew I was on the right track."

Rajesh was kept overnight at the hospital for observation. The following morning he underwent a barium swallow test, a special X-ray during which he drank a contrast liquid to enable the doctors to see how his esophagus was functioning. The test proved that his esophagus was clear and performing correctly, and there were no leaks or complications from the procedure.

What a relief that was, knowing it all had just gone off without any hitch," Rajesh added.

The Road to Full Recovery

Rajesh was taken on a liquid diet after the POEM procedure so that his esophagus heals completely. Several days later, he started taking soft food gradually, and within a few weeks later, he could get onto a regular diet. He was discharged home soon after the procedure with instructions on follow-up care in specifics.

In the days and weeks that followed, Rajesh continued to visit Marengo Asia Hospitals for routine check-ups. These follow-ups ensured that his recovery was progressing well and that he was free from any complications.

At follow-up one month later, another swallow study was repeated and confirmed that Rajesh's esophagus was now working correctly. He regained full recovery in the ability to swallow in the normal mode, and for the first time in years, he was able to eat again without discomfort or pain during his meals.

"I had forgotten what it was like to eat without fear," remarks Rajesh. "Thanks to the POEM procedure and the incredible team at the Center for Digestive Care, I have my life back."

Why Choose Institute of Gastroenterology and Digestive Health (IGDH)?

The Institute of Gastroenterology and Digestive Health at Marengo Asia Hospitals, Gurugram holds the top position in the advanced care of the gastrointestinal tract. Its capabilities for highly advanced procedures like POEM position it as a place to visit by patients who possess the most complex of conditions, such as achalasia. Using the latest technology and very experienced professionals, our institute makes sure that the best care is available to the patients, and that the whole experience from diagnosis to treatment and recovery is seamless.

At Marengo Asia Hospitals, each patient's journey is personalised to meet their unique needs. Rajesh's story is just one of many examples of how the hospital delivers compassionate, expert care, ensuring the best possible outcomes for all patients.

Take the First Step Toward Relief

If you or a loved one is struggling with achalasia or any other swallowing disorders, Marengo Asia Hospitals can help. Our gastroenterologists are always prepared to walk you through the treatment options, including state-of-the-art procedures, like POEM. Like Rajesh, you can experience the freedom and relief that comes with effective treatment.

Reach out to Marengo Asia Hospitals today and take the first step towards a healthier, more comfortable life.