POEM?

[Alan_M]

We quite often get asked about POEM - ( stands for per oral esophageal myotomy or something similar), and the issue is often whether the POEM procedure should take place, or the more conventional Heller's myotomy that also has a fundoplication wrap to recreate the valve effect of the lower oesophageal sphincter to stop reflux from rising.

A randomised controlled trial has taken place and has now been reported, comparing POEM with patients who had a myotomy with full Dor fundoplication:

nejm.org/doi/full/10.1056/N...

The study involved 221 patients. 83% of POEM cases were successful; 82% in the Heller's myotomy group. After 3 months the POEM patients had more reflux (57% rather than 20%) but after 2 years this changed to 44% and 29% respectively.

So the standard advice remains fair. If you go for POEM, think about the increased risk of suffering from reflux afterwards. This is logical when you consider that there is no equivalent of the fundoplication 'wrap' to combat reflux with POEM.

There is a more detailed description of the procedures in 'A Patient's Guide to Achalasia' that you can download from achalasia-action.org

[RheumerHasIt]

This has been my big question, regarding heller’s or POEM. When you look at the stats, you still can get GERD with Heller’s, just a little less often than POEM by about 20%**....but the percent of GERD in patients for both procedures seems to vary quite a bit, **depending on the study...

I am considering poem, as I would prefer the less invasive scarless approach, given that heller’s could STILL give you GERD as a result. Hmph.

As I understand it, you can always choose to do a fundoplication after the fact if you do a POEM. If you do a heller’s first and still have GERD, because of scar tissue they have a harder time going in to redo the fundoplication. Does this sound correct?....

[RheumerHasIt]

Im pretty interested if doing a 2 step procedure, a poem followed by a fundoplication, would be more precise in reducing acid reflux than a heller’s. I guess we just don’t know at this point...