For years, Art West, 71, had trouble swallowing. He eventually received a diagnosis of achalasia.
Achalasia is a rare digestive disorder affecting the nerves and muscles of the esophagus and lower esophageal sphincter (LES). This prevents the esophagus from squeezing food into the stomach due to a lack of proper muscle functioning.
Art initially decided to “manage his disease.” He was hesitant to undergo surgery. But in 2023, his symptoms worsened.
When he tried to eat, the food became stuck in his chest. He would throw up within 30 to 45 minutes after eating or drinking. He lost 110 pounds over five months.
“Swallowing was very difficult and uncomfortable. I got to the point where I couldn’t eat or drink anything,” says Art, a Hollidaysburg, Pa., resident “I just gave up trying.”
An Incisionless Procedure
Art made an appointment at UPMC. He initially saw Ryan Levy, MD, co-division chief, Division of Thoracic Surgery, UPMC, and chief of thoracic surgery, UPMC Passavant–McCandless. Dr. Levy had cared for Art’s wife, Terry, during her successful lung cancer treatment.
Dr. Levy attempted an endoscopic procedure to stretch Art’s esophagus and relax the esophageal sphincter. But during the procedure, he discovered that week-old food was still clogging Art’s esophagus and needed cleaning out.
He knew Art needed surgery to cut muscle fibers in his LES to allow food to pass. But due to his extreme weight loss and poor health, Art was no longer a candidate for traditional surgery.
Instead, Dr. Levy recommended that UPMC Passavant’s new gastroenterologist, Sultan Mahmood, MD, evaluate him. This way, they could determine whether Art could undergo an innovative, incisionless procedure to treat achalasia — a peroral endoscopic myotomy (POEM).
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A Specialized and Less Invasive Option
Though medicine and injections can provide temporary relief, surgery is necessary to treat severe achalasia. Until now, that meant surgeons had to make small abdominal incisions to reach the LES.
Dr. Mahmood is a specialist in interventional endoscopy, which uses advanced endoscopic technology to diagnose and treat certain conditions without surgery. He learned the POEM procedure through a fellowship at Beth Israel Deaconess Medical Center at Harvard University. Performing the procedure requires highly specialized training and complex medical decision-making.
POEM is a minimally invasive procedure performed during an endoscopy rather than through an incision, offering a quicker recovery without stitches. A small light and camera at the tip of the scope allow doctors to see and cut the muscle fibers to permanently open the lower esophageal sphincter.
“The POEM procedure eliminates the need for abdominal incisions,” explains Dr. Mahmood. “It is less invasive and has fewer complications, which is especially beneficial for older patients and those with complex issues.”
A Life-Changing Procedure
When Art met with Dr. Mahmood, he immediately felt at ease.
“He had answers for all my questions. He told me, ‘This will give you relief,'” says Art. “That put me at ease.”
Art admitted to feeling excited as his October procedure date approached. “I couldn’t walk, I couldn’t eat or drink, I couldn’t even talk. I just laid in my recliner.”
Art’s POEM procedure took about an hour. UPMC Passavant discharged him the following day after giving him a barium swallow contrast x-ray to make sure everything was working.
Before leaving, he “inhaled” his lunch — chicken broth, fruit cup, and gelatin dessert. A week later, he could begin eating soft foods.
“The first thing I ate was macaroni and cheese,” says Art. “When it went down, I started crying like a baby.”
He had a bucket ready, but the food stayed in his stomach. “After waiting about an hour, I asked for seconds,” Art says with a laugh.
Art says he had no side effects from the procedure — no pain, not even a sore throat. He is slowly regaining his strength — and weight — and looks forward to walking his dog again.
He especially enjoys eating now and is working his way through a long list of food items he compiled before his procedure. “I’m able to eat things I couldn’t even attempt before,” he says.
The POEM procedure was “life-changing,” says Art, who’s thinking about getting a tattoo of his surgery date. Art and his wife were so grateful to Dr. Mahmood and the nursing staff that they sent flowers to them after his discharge.
“I told Dr. Mahmood he saved my life,” says Art.
“We just wanted to say, ‘Thank you.’ Everyone at UPMC Passavant was wonderful and attentive. I couldn’t have received better care.”
About the POEM Procedure
POEM, or peroral endoscopic myotomy, is a new incisionless technique offered at UPMC Passavant–McCandless to treat achalasia. It can also treat other swallowing and digestive disorders.
This minimally invasive procedure has proved as effective (if not more effective) than the traditional laparoscopic approach. The latter procedure, called a Heller myotomy, is also for correcting the problems caused by achalasia. That’s according to Dr. Mahmood.
POEM involves guiding an endoscope through the mouth and down the esophagus rather than through abdominal incisions. The surgeon then cuts the muscle fibers that prevent the lower esophageal sphincter from opening. This helps widen the space for food to pass into the stomach.
The procedure lasts about one hour and requires general anesthesia. Patients usually spend one night in the hospital. They can leave after a barium swallow test shows everything is working normally.
According to Dr. Mahmood, POEM is about 90% effective in relieving symptoms in patients. But, he adds, the POEM procedure isn’t always the best option for everyone.
“Some patients are better suited for surgery or another intervention,” says Dr. Mahmood. “We work closely with specialists from different medical disciplines to develop the most appropriate, comprehensive, and tailored treatment plans for our patients.”
What Is Achalasia?
Achalasia is a rare swallowing disorder that occurs when the muscles at the bottom of the esophagus don’t work properly. Food often gets stuck in the esophagus before it eventually passes through.
Patients may throw up the food that doesn’t pass through. In addition to difficulty swallowing, this condition can cause extreme discomfort, weight loss, and pain.
Benefits of the POEM Procedure
The POEM procedure is a minimally invasive endoscopic treatment. Benefits for patients include:
- Less pain.
- Quicker recovery.
- No abdominal surgery or external scarring.
- Shorter hospital stays.
POEM Treatments for Other Gastrointestinal Disorders
UPMC Passavant also offers the POEM procedure to treat two other gastrointestinal disorders: gastroparesis and Zenker’s diverticulum. The procedures are slightly different for each condition that needs treatment:
- G-POEM, or gastric peroral endoscopic myotomy, is for treating gastroparesis — a condition by which the stomach doesn’t empty properly. The gastroenterologist uses a similar approach to the POEM procedure. They do this by cutting a different muscle where the bottom of the stomach meets the small intestine.
- Z-POEM is for treating Zenker’s diverticulum, a pouch that develops in the back of the throat and blocks food from entering the esophagus. The gastroenterologist cuts the dividing wall that’s formed where the small pouch bulges from the esophagus.
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