POEM

A Per-OralEndoscopic Myotomy(POEM) is a procedure in which the muscle layer in the oesophagus is cut. The procedure is performed entirely through the gastroscope, a narrow flexible tube with a camera that is inserted through the mouth into the oesophagus during the stomach examination (gastroscopy). Therefore, no incision is made in the skin.

This treatment is performed on patients with oesophageal motility disorders, such as achalasia, where the sphincter at the entrance to the stomach (also known as the ‘gastric valve’) is in spasm.

Observe the following guidelines strictly to avoid issues during the procedure:

If you take blood thinners (except Asaflow®), stop taking them in time. Consult your physician about this.

If you have gel nails, remove them from your index finger. This finger is important for measuring your oxygen levels in your blood during the examination.

Three days prior to surgery

Only consume liquid food (e.g. mixed soup, porridge or clear drinks)

One day before surgery:

only drink clear liquids (e.g. water, apple juice, sports drinks, clear broth, coffee (without milk) and cola)

The day of the surgery:

you need to have fasted for at least 12 hours before the procedure. This means that you are also not allowed to take any medication (exceptions to this are best discussed with the attending physician)

Come to our hospital at the appointed hour. There is no need to arrive earlier. In the atrium (entrance hall), proceed to one of the e-kiosks and sign in with your identity card. You will get a ticket via the e-kiosk with a tracking number that is displayed on the TV screens in the atrium’s waiting area. Your file will be completed and you will receive an identity bracelet with your last name, first name and date of birth. After registration, you will be directed to the waiting room of the day hospital.

You will be asked to change in a dressing room according to the time of your examination. Put on a surgical gown, dressing gown and non-slip stockings in the dressing room. These will be ready for you in the dressing room. You may continue wearing your eyeglasses (leave your lenses at home, only wear your glasses!), dentures and hearing aids until the examination. Your clothes must go into a sealed bag. After this, you will wait in a lounge area until it is your turn for your procedure. You can watch some TV in the meantime. Reading material is also available.

The nurse will take you to the preparation room. There, you take a seat on an examination table. Now your eyeglasses, dentures and hearing aids will go into a separate bag. You will have adhesive electrodes placed on your chest to monitor your heart rate, a meter attached to your fingertip to measure the oxygen level in your blood and an intravenous line will be inserted to administer the anaesthesia. You will then be taken to the examination room where you will see the anaesthetist and your physician for a short time before the examination.

A POEM is done under general anaesthesia. So, you will not feel anything from the examination. During the examination, you will be ventilated by a device through a tube placed in the trachea (intubation). Through the mouth, the endoscope is inserted into the oesophagus. The physician views the inside of the oesophagus on a screen and will determine the incision site. Through the endoscope, the doctor can insert instruments to make a small incision in the oesophagus, creating a tunnel between the superficial oesophageal wall and the muscle layer. The muscle layer is then cut. At the end of the procedure, the incision in the oesophagus is closed using clips.

After the procedure, you will be taken to the recovery room. Once you are well awake, a staff member will take you to back to your room. There, you can rest further. You will not be allowed to eat or drink immediately after the procedure, but you will be administered fluids through an IV. The day of the examination, your physician will discuss the preliminary results with you. Any follow-up consult will be arranged. Your GP will also receive a report about this.

The day after the procedure, the doctor will decide, after having seen you, whether you can resume eating or if further examination is necessary. By default, two nights in hospital are provided after the procedure. If you do not have a lot of symptoms and your eating is reasonably successful, you might be able to go home after just one night.

We are an experienced, well-trained team that has a modern endoscopy suite with all the necessary equipment. The anaesthesia is administered by an anaesthetist. Serious complications can arise after the examination, but this is a rare occurrence.

• You may experience some pain behind the breastbone after the examination. To ease this pain, the necessary medication will be administered. The pain typically recedes after one day.
• The main complications include bleeding, infection or oesophageal perforation. These are generally treatable, but you usually have to stay longer in hospital in this case.