POEM Procedure (Peroral Endoscopic Myotomy) for Achalasia Cardia

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POEM Surgery Peroral Endoscopic Myotomy for
Achalasia Cardia
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What is POEM Procedure?

• POEM stand for Peroral Endoscopic Myotomy
  procedure, in which Peroral means activity
  through the way of mouth, Endoscopic mean the use
  of endoscope to examine inside of body and
  Myotomy refers the incision made by the doctor.
  
• POEM procedure is a minimally invasive
  therapeutic endoscopic procedure to treat severe
  swallowing disorders through the mouth and
  treating certain esophageal disorders by cutting
  the muscles.
• This procedure is most commonly used for
  the treatment of achalasia cardia and spastic
  esophageal motility disorder.

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What is Achalasia cardia Spastic Esophageal
Motility Disorder (EMD)?

• Achalasia cardia is a rare disorder but
  common motility disorder making it difficult for
  food and liquid to pass into the stomach.
• Achalasia cardia occurs when nerves in the
  esophagus are damaged. As a result, the esophagus
  becomes numb, dilates over time, and eventually
  loses the ability to squeeze food into the
  stomach.
• Spastic Esophageal Motility Disorder
  (EMD) is a disorder thats characterized by
  uncoordinated contractions of the esophagus that
  can cause swallowing difficulties, muscles spasms
  or regurgitation of the food back to mouth.
• There are different types of EMD such as
  diffuse esophageal spasm, nutcracker esophagus
  and hypertensive lower esophageal sphincter.

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What is Gastric Peroral Endoscopic Myotomy
procedure (G-POEM)?

• Gastroparesis is a motility disorder that
  affects normal movement of the stomach muscles,
  resulting in improper emptying of the stomach.
• It is usually found in patients with
  diabetes complications or surgery or some
  medicine that can slow down the stomach emptying
  process. This may result in nausea, vomiting,
  abdominal pain, bloating, weight loss, acid
  reflux etc.

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How Gastroenterologists Selects Patient for POEM
Procedure?

• After having following investigations and
  diagnosis, patients suffering with swallowing
  difficulties are advised for the POEM procedure
• Esophageal Manometry  It is a test to assess
  motor function of the esophageal body, upper and
  lower esophageal sphincter. By doing this test
  doctor can differentiate the type of achalasia
  cardia type1, type 2 and type 3. It also
  diagnoses the spastic esophageal motility
  disorder.
• X-ray Barium Swallow - It is a radiology
  examination for the upper gastrointestinal (GI)
  tract. By this doctors can diagnose structural or
  functional issues of the upper GI tract.
• Upper GI Endoscopy - It is a non-surgical
  procedure used to find out the disease and
  conditions related to digestive system like
  difficulty swallowing, abdominal pain, gastritis,
  and ulcers, bleeding in digestive tract, bowel
  habit changes, colon growth or polyps.
• 24 hour PH Metry  It is a test to assess 24
  hours monitoring whether acid is coming back into
  the esophagus from the stomach causing pain,
  nausea, heartburn, and chest pain

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What are the Advantages of POEM Procedure?

• POEM procedure is a new endoscopic
  technique and have better results than Hellers
  Myotomy (Laparoscopic Surgical Procedure) and
  Balloon Dilation (with a high recurrence rate).
• Benefits of POEM procedure are as follows
• Scar less endoscopic procedure 
• Requires less sedation during procedure
• Shorter operative time
• Very minimal blood loss
• Shorter hospitalization
• Quicker recovery time
• Less risk of infection post procedure
• Effective in patients those previous surgeries
  was not successful

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What Can a Patients Expect before POEM Procedure?

• The procedure requires certain prerequisite
  that need to be followed by the patient before
  the POEM Surgery
• Patients need to follow a liquid diet for at
  least 48 hours to clear the esophagus and stomach
  so that the procedure can happen smoothly.
• Patients are required to be fasting for 12 hours
  before the procedure. In case of heart conditions
  or diabetes, patients are advised to discuss with
  the assisting doctors before taking medicines for
  pre-existing diseases.

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What Can a Patients Expect after POEM Procedure?

• Post POEM Procedure a patients would
  experience the following situation and activities
• doctor will monitor to make sure there are no
  complications.
• further to that after 24 to 48 hours doctor will
  do X-ray barium follow through test to confirm
  esophagus is open and there is no leakage happen
  afterwards.
• once everything is fine, the patient will be
  discharged, can go home, and follow the diet and
  medications as advised.

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