A minimally invasive solution to an uncomfortable issue

Several years ago, Ronald Leming, 75, developed an embarrassing problem. Every time he ingested food or a beverage, it came back up. He was vomiting about 85 percent of the things he ate or drank. Every day for more than a year.

After becoming somewhat of a recluse, Ronald learned he was suffering from esophageal achalasia. Achalasia is a rare motility disorder that makes it difficult for food and liquid to pass into the stomach because the nerves in the esophagus are damaged. As a result, the esophagus loses the ability to squeeze food down and the esophageal sphincter doesn’t fully relax, blocking access to the stomach.

Ronald was referred to Neil Sharma, MD, president, Parkview Cancer Institute, and director, advanced interventional endoscopy and endoscopic oncology, Parkview Health, to explore options for treating his achalasia. And on August 30, 2018, he became the first patient in northeast Indiana to undergo a Peroral Endoscopic Myotomy (POEM) procedure under Dr. Sharma’s direction.    

“I would recommend this procedure to anybody suffering from what I suffered from,” Ronald said. “It really changed my life.”

POEM is a minimally invasive procedure that uses an endoscope to access the inner muscle layers of the esophagus. The muscle is trimmed and resected from the body from the top of the esophagus down toward the stomach, which relieves the tightening of the esophageal sphincter to create a whole large enough for food and liquids to enter the stomach.

“There were no cuts and no scars. And I no longer have to take tiny bites to accommodate the tiny entrance to my stomach,” Ronald shared.

We asked Dr. Sharma to share more on the details of this life-changing procedure.

Conditions

We are seeing the POEM surgical technique extended to all types of achalasia of the esophagus, as well as for gastroparesis or tunneling to remove tumors.

Symptoms

Difficulty swallowing is the main symptom of achalasia. This is often experienced when consuming both solids and liquids. Additionally, some patients with subtypes of achalasia may experience spasms or chest pain.

Benefits of the procedure

Patients experience a shorter stay in the hospital, usually just overnight. They can typically resume regular activity and are back to work much sooner as well.

POEM is a surgical treatment, and, as with all treatments, there are pros and cons to consider. There are less invasive treatments, such as Botox® injections to the muscle and balloon dilation, but surgical options can have longer, sustained effects. In the past, the surgery was only done through external laparoscopic incisions, referred to as “Heller myotomy”. With POEM, we make those incisions internally, which has obvious advantages in recovery. Additionally, the surgery can be tailored to the subtype of achalasia and the patient’s anatomy.

In cases where it’s necessary, the myotomy, or cutting of the muscle, can be extended higher up into the chest and be done in the front or back of the organ. POEM cannot be done with laparoscopic Heller surgery, as the incision is through the abdomen in the front only.  

Referral 

If you suspect you or a loved one is suffering from esophageal achalasia, contact your primary care physician or the Interventional Oncology and Surgical Endoscopy team by calling (260) 266-5221 or (260) 266-5224.

 

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