Peroral Endoscopic Myotomy (POEM)
When your child has trouble swallowing food or liquids, Nationwide Children's Hospital offers cutting-edge procedures for our patients, including peroral (also known as Per Oral) endoscopic myotomy (POEM). This procedure is less invasive than other treatments and helps to treat swallowing disorders caused by muscle spasms in the esophagus.
Muhammad Khan, MD, MPH, FASGE, is a pediatric gastroenterologist and director of interventional and diagnostic endoscopy at Nationwide Children’s. Dr. Khan is one of only a few endoscopists trained and experienced in performing both esophageal and gastric POEM procedures in children.
What Is Peroral Endoscopic Myotomy (POEM)?
POEM is a minimally invasive procedure that can effectively treat the symptoms of gastroparesis (when muscles in the stomach don’t move food along to be digested) or swallowing disorders like achalasia.
Achalasia is a rare swallowing disorder that affects the ability of the esophagus to move food down to the stomach. Symptoms of achalasia can include difficulty swallowing food and even liquids, chest pain and throwing up (regurgitation) of food. These symptoms can be frustrating and even debilitating, making it difficult for patients to eat normally. Significant weight loss often occurs as a result.
POEM at Nationwide Children’s
POEM is a newer endoscopic procedure that doesn’t require traditional surgery to treat various conditions, such as achalasia, esophageal spastic disorders, gastroparesis and pyloric stenosis. While there are several endoscopists who can perform POEM procedures for adults, very few can safely do this procedure in children.
One pioneer in this area is Muhammad Khan, MD, MPH, FASGE, pediatric gastroenterologist and the director of interventional and diagnostic endoscopy at Nationwide Children’s. Dr. Khan completed extra training in interventional endoscopy that includes the surgical endoscopy skills for POEM, as well as endoscopic ultrasound, pancreaticobiliary endoscopy and complex polyp resections.
Is POEM Right for My Child?
Children with swallowing or motility disorders like achalasia or gastroparesis may be considered candidates for a POEM procedure. The gastroenterology team will consider your child’s condition, previous testing, and may recommend additional testing to ensure the best care for your child.
What Should I Expect Before My Child Has POEM?
Before undergoing a POEM procedure at Nationwide Children’s, your child will receive a full medical and surgical evaluation. The team will review various treatment options best suited for your child. If the medical team decides your child would benefit from POEM, you will receive detailed instructions to help prepare for the procedure.
How Is POEM Done?
The POEM procedure is performed via endoscopy. An endoscope is a long, thin, flexible tube which has a camera on the end. Through the endoscope, various tools are passed to perform diagnostic testing and interventional therapies. During the POEM procedure, the endoscope is passed down the mouth and into the esophagus or stomach. A small cut (incision) is made in the inner lining of the esophagus or stomach, and then the affected muscle layer is exposed. The muscle layer is then cut (called a myotomy), allowing the muscles to relax and food to pass through more easily. The small incision is finally closed with a few tiny clips, and the lining heals.
What Happens After POEM?
Patients will recover from anesthesia after the procedure. Once the patient wakes up, the doctor will talk about the results. Most patients spend one night in the hospital after the procedure. Your child may be given medicine for pain. Your child may have a sore throat for a few days. Your doctor will discuss diet, but in many cases your child can start eating regular food in about a week.
What Are the Benefits of POEM Over Other Procedures?
A Heller myotomy is a more traditional treatment approach. While it is considered minimally invasive, it does involve making several small incisions in the belly (abdomen) to reach the esophagus. A Heller myotomy can include a higher risk of complications like bleeding or infection from the incisions. Benefits of a POEM procedure include:
- It is less invasive than traditional procedures like a laparoscopic Heller myotomy
- It requires shorter recovery time (typically, patients only need a single night of monitoring before discharge, versus a week-long stay after a Heller myotomy)
- It results in fewer complications than traditional surgical procedures (with success rates ranging from 92 – 96% in children)
What Are Risks from POEM?
Risks from the POEM procedure are rare, but may include:
- Gastroesophageal reflux disease (GERD)
- Risk of infection
- Bleeding from the esophagus
- Tearing of the esophagus
- Pneumothorax, when air leaks into the space between the lung and chest wall and causes the lung to collapse
- Pneumomediastinum, when air leaks into space between the lungs and causes discomfort
Learn About the Motility Center
Why Nationwide Children's?
At Nationwide Children's, we are uniquely equipped to handle the care of pediatric patients with swallowing disorders like achalasia. There are not many surgeons who are trained to perform complex endoscopy procedures, like the POEM procedure, in pediatric patients. Muhammad Khan, MD, MPH, FASGE, pediatric gastroenterologist and the director of interventional and diagnostic endoscopy, specializes in performing POEMs.
Dr. Khan received additional training in interventional endoscopy to treat more children using less invasive strategies. His surgical skills include POEM, endoscopic ultrasound, pancreaticobiliary endoscopy and complex polyp resections. He is the only pediatric gastroenterologist in the United States performing all of these interventional endoscopy procedures in pediatric patients.
Our team, combined with our state-of-the-art equipment and facilities, allow us to provide the highest level of care for our patients, ensuring that they receive the best possible outcomes from their procedure. We are committed to working closely with our patients to develop personalized treatment plans that meet their unique needs and help them achieve the best possible results.
If you know of a child that is experiencing swallowing disorders like achalasia, we encourage you to contact us to learn more about the POEM procedure and how it can help. Our team of experts is here to answer your questions and guide you through the process, ensuring that you receive the care and support your child needs to achieve optimal health and wellbeing.
