New Minimally Invasive Procedure Treats Debilitating Swallowing Disorder


MAYWOOD, IL – Loyola Medicine is among the first centers in Illinois to offer a new minimally invasive procedure to treat a debilitating swallowing disorder called achalasia.

The procedure is called peroral endoscopic myotomy (POEM). A gastroenterologist performs the procedure with an endoscope that is inserted through the patient's mouth. There are no incisions or scars, minimal pain and a fast recovery.

"POEM is an easily tolerated procedure that makes a dramatic lifestyle difference in patients," said Loyola gastroenterologist Nikhil Shastri, MD, who is among a handful of Chicago-area physicians who perform POEMs.  

Achalasia impairs swallowing in two ways. The esophagus (the tube connecting the throat to the stomach) does not effectively squeeze food down. Also, the muscular valve between the esophagus and the stomach, called the lower esophageal sphincter, doesn't relax sufficiently to allow food to enter the stomach. Eating food with achalasia is like trying to squeeze toothpaste out of the tube with the cap on, Dr. Shastri said.

Symptoms of achalasia include difficulty swallowing food and liquids, regurgitation of food, heart burn, chest pain, coughing and weight loss.

In the POEM procedure, Dr. Shastri inserts an endoscope in the patient's mouth and guides it to the lower esophagus. Using tiny tools that are passed through the endoscope, Dr. Shastri relieves the tightness in the esophageal sphincter, thus allowing food to pass to the stomach.

Following the procedure, the patient typically stays in the hospital for two days and returns to work the following week. Pain is minimal. Most patients require only a few doses of pain medicine, and some patients take no medication at all. Patients are restricted to a liquid diet for the first seven days, then transition to soft foods before eating solid foods.

The POEM procedure is an alternative to a laparoscopic procedure called a Heller myotomy, in which surgical instruments are inserted through multiple small incisions in the chest. While a laparoscopic Heller myotomy is less invasive than open surgery, it still is more painful and involves a longer recovery than a POEM procedure, Dr. Shastri said.

But not all gastroenterologists are able to offer POEM. "It's a technically challenging procedure that requires specialized training and advanced surgical backup," Dr. Shastri said. "POEM is an example of the advanced, subspecialty treatments available at academic medical centers such as Loyola."

Loyola Medicine is nationally ranked by U.S. News & World Report for its expertise in diagnosing and treating a broad range of gastrointestinal conditions and providing integrated services for optimal patient care.

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