While POEM has revolutionized the treatment of swallowing disorders like achalasia, it has also emerged as a minimally invasive alternative for treating other rare oesophageal disorders, offering patients a safer and more effective solution than traditional surgery. Disorders such as diffuse oesophageal spasm (DES) and Jackhammer oesophagus, which are characterized by painful and disorganized contractions of the oesophagus, are now being successfully treated with POEM. Although these conditions are less prevalent than achalasia, they can severely affect a patient’s quality of life, resulting in challenges such as difficulty swallowing, intense chest pain, and regurgitation. As POEM continues to advance, it is becoming a prominent treatment choice for individuals facing these intricate and demanding disorders.
Understanding rare oesophageal motility disorders
While achalasia is well-known, conditions like diffuse oesophageal spasm and Jackhammer oesophagus often go undiagnosed due to their diverse symptoms and similarities to other gastrointestinal issues. Diffuse oesophageal spasm (DES) is marked by uncoordinated and forceful contractions of the oesophagus, which can lead to sporadic swallowing difficulties and chest pain that may resemble a heart attack. Conversely, Jackhammer oesophagus represents a more severe variant of DES, characterized by excessively strong and prolonged contractions that render swallowing extremely painful. Both disorders stem from nerve dysfunction within the oesophagus, resulting in abnormal muscle contractions. Traditional treatment options include dietary changes, medications such as calcium channel blockers and nitrates, or botulinum toxin injections aimed at relaxing the oesophageal muscles. However, these methods frequently offer only temporary relief. In this context, POEM has emerged as a transformative solution, providing a long-lasting remedy for patients who have faced challenges with conventional treatments.
How POEM Works for rare oesophageal motility disorders
POEM utilizes an endoscope, a flexible tube equipped with a camera, to access the oesophagus via the mouth, thereby eliminating the necessity for external surgical incisions. The procedure consists of several essential steps –
- Creating a submucosal tunnel – A minor incision is made in the oesophageal lining to create a tunnel, facilitating access to the dysfunctional muscle layers.
- Performing myotomy – The excessively strong or uncoordinated oesophageal muscles are meticulously severed, which prevents abnormal contractions and enables food to pass smoothly into the stomach.
- Closing the incision – The tunnel is secured with endoscopic clips, promoting a smooth healing process without leaving external scars.
In cases of diffuse oesophageal spasm, the procedure concentrates on severing the areas responsible for uncoordinated contractions. For Jackhammer oesophagus, POEM proves particularly beneficial as it directly targets the excessive muscle contractions by relaxing the affected segments of the oesophagus. In contrast to conventional treatments that may offer only temporary relief, POEM provides enduring results by addressing the underlying causes of these conditions.
Comparing POEM to other treatment options
Prior to the advent of POEM, individuals suffering from diffuse oesophageal spasm or Jackhammer oesophagus faced a limited array of treatment alternatives. Pharmacological management utilizing agents such as calcium channel blockers, nitrates, or muscle relaxants often provided inconsistent relief and was frequently accompanied by adverse effects, including dizziness and hypotension. Pneumatic dilation, a procedure that entails the inflation of a balloon within the oesophagus to stretch and weaken the affected musculature, exhibited variable success rates and posed a considerable risk of perforation. Heller myotomy, a laparoscopic surgical intervention that involves severing the oesophageal muscles, necessitated abdominal incisions and resulted in a prolonged recovery period, rendering it a more invasive option.
In contrast, POEM presents several significant benefits. Its minimally invasive nature negates the requirement for external incisions, thereby reducing pain and the likelihood of infection. The procedure’s high degree of precision, facilitated by the use of an endoscope, ensures that only the targeted muscle layers are incised, thereby minimizing damage to adjacent tissues. Patients experience quicker recovery times, with the majority being discharged within 24 to 48 hours and returning to their normal activities much sooner. Furthermore, POEM has shown sustained effectiveness, with research indicating long-lasting symptom relief for oesophageal motility disorders, establishing it as the preferred option for numerous specialists.
Patient eligibility for POEM in rare oesophageal disorders
Not every individual diagnosed with diffuse oesophageal spasm or Jackhammer oesophagus is an immediate candidate for POEM; a comprehensive diagnostic assessment is essential to ascertain the appropriateness of the procedure. Standard diagnostic evaluations include oesophageal manometry, which assesses the strength and coordination of oesophageal contractions to identify abnormal motility patterns, the barium swallow test, which allows visualization of food movement through the oesophagus to detect spasms or blockages, and endoscopy, which is utilized to exclude structural abnormalities or inflammation that may resemble oesophageal motility disorders. Patients who persistently suffer from severe symptoms despite pharmacological or other non-invasive interventions are considered ideal candidates for POEM. Furthermore, POEM is applicable to individuals across all age groups, making it a viable option even for elderly patients who may not be suitable for conventional surgical procedures.
POEM represents a significant advancement in the treatment of rare oesophageal disorders such as diffuse oesophageal spasm and Jackhammer oesophagus. Its minimally invasive nature, precision, and long-term efficacy provide renewed hope for affected individuals. As technological advancements continue, POEM is poised to enhance patient outcomes, restoring comfort and confidence for those facing swallowing challenges. Mission Gastro Hospital stands as a trusted centre for POEM treatment in Ahmedabad, delivering expert care through advanced endoscopic techniques. With a proficient medical team and cutting-edge facilities, patients benefit from precise, minimally invasive interventions for rare oesophageal disorders, facilitating quicker recovery and an enhanced quality of life.
