New Procedure Can Help with Motility or Swallowing Disorders
July 27, 2018
Patients suffering from esophageal motility or swallowing disorders can be prone to several digestive issues, including difficulty in swallowing, severe heartburn and regurgitation (gastrointestinal reflux disease), constipation, gas, vomiting, bloating, abdominal pain and weight loss.
When nerves or muscles in the digestive tract don’t work properly, the resulting motility can affect the GI tract from the esophagus all the way to the colon and rectum.
Now a new minimally-invasive procedure is available to patients with esophageal motility disorders. Kalyana Nandipati, MBBS, director of the Esophageal Surgery Center at CHI Health Creighton University Medical Center – Bergan Mercy performs the procedure along with GI Specialist Subhash Chandra, MBBS, Director of Esophageal Diseases and Intestinal Dysmotility. It’s known as Per-Oral Endoscopic Myotomy (POEM). One of its uses is for patients with achalasia, a condition in which muscles in the lower esophagus fail to relax and prevent food from passing into the stomach.
Endoscopes are flexible tubes that can be passed through the mouth for doctors to examine the esophagus, stomach, intestine and colon with making incisions. The endoscopic approach is normally outpatient, can take between one to three hours and offers a faster recovery for patients. A hospital stay usually is not required.
Only a few centers in the country offer this less invasive solution to swallowing disorders.
“We make an incision in the mucosa of the esophagus and create a tunnel between the mucosal lining and the muscle layer from the esophagus to the stomach,” said Dr. Nandipati. “Staying in that tunnel we divide the muscle.” Dr. Nandipati has performed these POEM procedures for patients with achalasia and with Zenker’s diverticulum, where a small pouch forms and collects food in the throat.
POEM was also used for a patient with a two to four cm. tumor in the muscle layer of the esophagus. This procedure, known as POET (Peroral Endoscopic Tumor Resection), was performed first in the region in July 2018 with successful removal of the esophageal muscle tumor.
"It's almost like you peel back the layers of an onion and remove the tumor from the inside,” Dr. Nandipati said. With the joint program, surgeons and GI specialists work with each patient. “Collaboration ensures it is the right approach, or we can steer patients to a different procedure, if appropriate,” Dr. Nandipati said.
Because it’s relatively new, insurance can be a limiting factor though POEM has been performed for Medicare patients.
POEM originated in Japan, and only recently has been performed in the United States.
Are you a candidate for POEM?
Talk to your primary care provider about a referral if you think you may be a candidate for POEM.