Peroral Endoscopic Myotomy

What is peroral endoscopic myotomy (POEM)? 

Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure used to treat esophageal achalasia, an esophageal disorder which causes an abnormality in the esophagus making it difficult to swallow. 

In patients with esophageal achalasia, the lower esophageal sphincter is too tight and treatment options seek to weaken the lower esophageal sphincter.  The POEM procedure uses upper endoscopy (a thin, flexible tube inserted through the mouth and into your esophagus) rather than convention surgery, which involves an incision in the skin.

POEM was developed in 2008 and has traditionally been performed on adult patients. C.S. Mott Children’s Hospital performed their first POEM procedure on a pediatric patient in 2022 and is one of few pediatric hospitals in the country to offer this less invasive treatment option to older children and teens. 

How is POEM performed?

While your child is under general anesthesia, a flexible endoscope is inserted into the mouth and down the esophagus.  A tiny camera on the endoscope allows the endoscopist to view the inside of the esophagus when they then make a small incision in the innermost layer of the esophagus (the mucosa). The endoscope is then tunneled through the incision and down the remaining length of the esophagus in the layer called the submucosa. In the lower esophagus, the endoscopist cuts the muscle fibers of the lower esophageal sphincter. The endoscope is then removed and the first incision made in the mucosa is closed to complete the procedure.

Who is eligible to receive POEM?

A consultation with your child’s doctor can best determine if POEM is the right procedure for them. POEM may not be the best option for younger children because the size of equipment was originally developed for adults.  Therefore, it is not small enough to be used on younger children. The procedure is best used to treat older children or teens with esophageal achalasia, typically over the age of 10.

How to prepare for POEM?

Since your child will be under general anesthesia, they cannot eat or drink for 12 hours prior to the procedure.  Your child will also be prescribed an antibiotic to take before and after the procedure to help prevent infection.

What is recovery after POEM like?

Your child will be observed in the hospital overnight.  An esophagram (X-ray of the esophagus) is taken the next day to show that the procedure was successful prior to resuming eating and returning home.  Your child will be asked to consume a liquid diet for following discharge, and this will later transition to soft food and advance to a regular diet as tolerated.

Next step

To learn more about the POEM procedure or to schedule an appointment, call 734-936-5738.