Patients with a disorder of the esophagus that makes swallowing difficult now have a local option for advanced endoscopic surgery that can provide relief.
Houston Methodist Sugar Land Hospital surgeon Aman Ali, M.D., recently performed the first-ever peroral endoscopic myotomy (POEM) procedure in Fort Bend County to treat a patient with achalasia, a disorder caused by nerve damage to the esophagus. People with achalasia have difficulty swallowing food and liquids and often will regurgitate undigested food. Without treatment, achalasia becomes progressively worse and can be life-threatening because it increases the risk of choking or pneumonia from the aspiration of food into the lungs.
The traditional treatment for achalasia is a surgical procedure called Heller myotomy, which involves multiple incisions on the abdomen. The POEM procedure is a non-invasive approach to esophagogastric myotomy, using a flexible endoscope inserted through the mouth into the esophagus. Once in place, the physician makes an incision in the esophageal mucosa, which is the inside layer of the esophagus. Then, this incision creates a submucosal tunnel to expose the tight lower esophageal sphincter muscle. The surgeon then cuts this muscle at the lower esophageal sphincter, which is called a myotomy, making it easier for food and liquid to pass through.
“Because we aren’t making incisions to the skin and muscles in the abdomen and chest area, the patient heals more quickly and has less post-operative pain,” Ali said. “It’s a more effective approach to treating achalasia than traditional open Heller myotomy or even minimally invasive laparoscopic Heller myotomy.”
Patients typically spend one night in the hospital and undergo a swallow study before being released.
Ali’s patient for that first procedure was 79-year-old Beatrice Pickard of Friendswood, whose achalasia had progressed to the point where she couldn’t eat or drink anything without vomiting. Pickard’s procedure was successful, and following a short hospital stay, she returned home.
“I never had any pain of any kind,” she said. “It was easy.”
After surgery, Pickard was on a liquid diet for several weeks and has now progressed to a soft diet. After her next follow-up visit, she expects to return to eating solid foods.