Surgery to treat esophageal achalasia used to be performed by cutting into the abdomen via “open surgery.” Then medicine advanced to treat the condition laparoscopically, using a few small incisions to pass instruments through to perform a cut of muscles (also referred to as a “myotomy”). Thanks to Neil R. Sharma, MD, Parkview Health President, esophageal achalasia is now treated endoscopically, n incisions through the skin, with a tube going down the patient’s throat to operate internally.
What Is Esophageal Achalasia?
Esophageal achalasia is a motility-movement disorder of the esophagus that causes trouble swallowing. It has two main conditions. First, the lower esophageal sphincter (“LES”), which separates the esophagus from the stomach, is too tight, so it can’t open enough to let food pass through to the stomach.
Second, the rippling motion of the esophagus, known as peristalsis, is too weak to move food down through the esophagus and past the LES. The two problems combine to make it difficult, if not impossible, for the patient to swallow. People with severe achalasia may need a feeding tube that runs through their nose down to their stomachs.
How Does Dr. Sharma Treat Esophageal Achalasia?
Thanks to innovators in the field of endoscopy, such as Dr. Neil R. Sharma, esophageal achalasia is now treated by using peroral endoscopic myotomy. Peroral means through the mouth. A myotomy is a procedure that cuts muscle. A POEM uses a tube through the mouth that cuts the LES muscle to loosen it up.
Dr. Neil Sharma passes the endoscope through the patient’s mouth into the esophagus. He injects fluid into the submucosal layer, the layer under the inner lining of the esophagus, to create a space to work. Next, he cuts through the mucosal layer, that lining, to create a tunnel down through the submucosal layer to access the muscle layers that lie beneath it.
That tunnel will extend from the esophagus, through the LES, and into the stomach, loosening the LES to allow it to let food pass through from the esophagus into the stomach. The exact length of the tunnel will depend on the specific type of achalasia the patient has. Finally, the incision in the mucosal layer is closed using endoscopic clips.
Who Is Eligible for a POEM?
Patients whose achalasia is having a profound impact on their quality of life are eligible for a POEM. They must have severe difficulty swallowing, making it hard to put weight on or lose weight. Each patient will be thoroughly evaluated through endoscopy, motility studies, and having their medical history carefully examined to make sure they have the correct diagnosis and that they are a good fit for the surgical procedure known as POEM.
Neil R. Sharma MD is one of the leading GI and endoscopists in the U.S. He is double board certified in internal medicine and gastroenterology, and he did an additional fellowship in interventional endoscopy, where he focused on GI malignancies and complex, minimally invasive surgical procedures such as the POEM procedure.