OUR EXPERT ANSWERS YOUR QUESTIONS
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Lionel S. D’Souza, MD To learn more about the POEM procedure, |
The Division of Gastroenterology and Hepatology at Stony Brook Medicine continues to expand its minimally invasive interventional endoscopy program. Dr. Lionel S. D’Souza, Chief of Endoscopy, was the first physician in Suffolk County to perform the POEM procedure. Dr. D’Souza explains how POEM offers patients the most advanced treatment alternative to traditional surgery for certain gastrointestinal conditions, including achalasia.
What is the POEM procedure?
The term POEM is an easy way to remember: PerOral Endoscopic Myotomy. POEM is a minimally invasive procedure to permanently open up various malfunctioning sphincters (a ring of muscle) in the body. The most common sphincter for which this procedure is used is the lower esophageal sphincter (LES) in a disease called achalasia. POEM provides long-term relief of symptoms in achalasia, which is a rare, potentially debilitating swallowing disorder that makes it hard or impossible for food and drink to enter your stomach.
What happens during the procedure?
During the procedure, I don’t make any incisions on your body. Everything is done internally with an endoscope, which is a thin, flexible tube with a camera. I guide the endoscope through your mouth and into your esophagus. Then, using a small knife that passes through the endoscope, I widen the passageway, so food can travel from your esophagus to your stomach.
Who may need the POEM procedure?
A POEM may be an option for treatment for certain diseases with malfunctioning sphincters. With achalasia, your esophagus and its sphincter don’t work properly, so food and liquids get “backed up.” The esophagus is the tube that carries what you eat from your mouth to your stomach, and the sphincter acts like a valve that opens to let the food pass into the stomach. When food sits in your esophagus for long periods of time, the esophagus lining becomes inflamed and causes symptoms. These can vary depending on the severity of the disorder and may include the sensation of food getting stuck, regurgitation, vomiting, chest pain and weight loss. It can also interfere with your quality of life because eating and drinking are so difficult. Other conditions with malfunctioning sphincters, for which POEM may be a treatment option, includes gastroparesis (also referred to as G-POEM or POP) or Zenker diverticulum (referred to as Z-POEM).
Why is the POEM recommended?
POEM is a minimally invasive treatment and a good alternative to the traditional surgery, called a Heller myotomy, which is performed laparoscopically and requires multiple incisions in your abdomen. The POEM procedure offers the same results as surgery with minimal pain and a fast recovery..
Are there any restrictions on who can have the procedure?
There are no major restrictions on who can undergo a POEM. While age usually isn’t a factor — both children and adults can have the POEM — previous surgeries on the esophagus may require further evaluation prior to the procedure. You will have an initial consultation with me in the office to determine if POEM is the best option for you. If you have underlying conditions such as heart and lung problems, I will ask you to get evaluated by your cardiologist and/or pulmonologist before proceeding.
What would the process be like for me?
You’ll be given specific instructions on how to prepare for the procedure. This will likely include a liquid diet for a couple of days and a fasting period the day before. We’ll also discuss when and how to take your medications and supplements. I do this procedure with general anesthesia in the Endoscopy Unit at Stony Brook University Hospital. It takes about an hour and most people go home the same day. For most patients, the POEM has a short recovery time and low risk of bleeding and infection. Your throat may be sore for a few days afterwards. You’ll be given a diet plan, which includes a liquid diet for two to three days after the procedure, before advancing to a normal diet within a week.
Are there any risks or complications?
Because it’s minimally invasive, the POEM is a very safe procedure. While complications are rare, there is a possibility of inflammation around the esophagus, infection, bleeding, or an air bubble in the peritoneal cavity (pneumoperitoneum) or between the lungs (pneumomediastinum). These are rare (1-3%) and usually resolve on their own or are easily managed during the procedure. Some people may develop gastroesophageal disease (GERD) after this procedure, which is also easily managed.
What’s the Stony Brook difference?
I performed the first POEM procedure at Stony Brook University Hospital in 2017. Since then, our team has developed a state-of-the-art multidisciplinary program to guide you through a seamless process from diagnosis to treatment to recovery. Our thorough approach is responsible for the excellent results we have seen. Our Motility Center uses the latest technology for the initial diagnosis and accurate assessment of your disease, so that the treatment options are tailored to you. Our dedicated staff and highly trained and experienced endoscopy team assure the best experience and outcomes for our patients at Stony Brook.
To learn more about the POEM procedure, call (631) 444-5220.