PerOral Endoscopic Myotomy (POEM)

Third space endoscopy is an endoscopic technique requiring high skills where in gastrointestinal tract wall which is 3 - 5 mm thick is split at the submucosal level to create a tunnel for introducing a 9 mm diameter endoscope. The endoscope is introduced through the mouth or anal canal and enters the third space through mucosa and there is no cut on the skin. Achalasia cardia is a condition in which the lower end of the food pipe does not allow food to pass into the stomach due to a tight ring of muscular tissue at the lower end of the food pipe.

“PerOral Endoscopic Myotomy” (POEM), is a third space endoscopic procedure where the endoscope is passed through the mouth and a submucosal tunnel is created from the upper part of the esophagus till the lower end where the ring of muscle constricting the lower part of the esophagus is cut to allow easy passage of food into the stomach and the tunnel entry is closed with metallic clips. This procedure requires a stay of 3 - 4 days in the hospital.

The POEM procedure is done through a tiny 2.8 mm channel built inside the endoscope. Specially designed instruments are passed through the channel to cut, control bleeding and to close the mucosal opening.

In order to facilitate this procedure, we have an Olympus 180 series endoscopic processor, light source, gastroscope along with the electrosurgical unit, which was added to the department in October, 2023. Two POEM procedures were done under the able guidance of the Administrator Sister Sandhya and Medical Director Dr. Shankar Prasad. Both patients presented with difficulty in swallowing and underwent endoscopy and esophageal manometry. Both the patients tolerated the procedure well with good results and were discharged. It is to be noted that the POEM procedure is done only in a few hospitals in Bangalore, and this includes St. Philomena’s Hospital at Viveknagar.