Peroral endoscopic myotomy (POEM)

Eating should feel natural, but conditions like achalasia can make every meal stressful and painful. When the muscles at the bottom of the esophagus fail to relax (esophageal dysmotility), food gets stuck, causing choking, pressure, or discomfort. Peroral endoscopic myotomy (POEM), also called esophageal myotomy, is a minimally invasive option that helps relax these tight muscles. The POEM procedure allows many people to swallow more easily and to eat comfortably again.

This treatment is typically performed by gastroenterologists who specialize in advanced endoscopic care. At Penn Medicine, our gastroenterologists pioneered the use of endoscopic ultrasound, advancing the detection and treatment of complex digestive diseases. This advanced endoscopy expertise allows us to offer you the best care.

If you have trouble swallowing (dysphagia), chest discomfort after eating, or frequent regurgitation, you may be a candidate for the POEM procedure. This is often due to conditions like achalasia, Zenker’s diverticulum, and other issues that affect how the lower esophageal muscles work.

The treatment is often recommended when symptoms are persistent or when other therapies like medications or dilation haven’t provided enough relief. POEM is also ideal for people who are unable to have open surgery or who can’t have other endoscopic procedures.

The POEM endoscopy is a minimally invasive procedure, so no external cuts are needed. You’ll be given medication to make you comfortable. Your gastroenterologist uses a flexible tube called an endoscope to reach the esophagus through the mouth. They’ll gently create a tunnel in the esophageal wall and cut the tight muscle fibers so food can pass more easily. The entire process usually takes one to three hours. Most people feel comfortable during the process, and many return home the same day or after an overnight stay.

POEM recovery is usually quicker than with traditional surgery. You’ll likely be on a liquid or soft-food diet for a short period while your esophagus heals. You may feel a bit of throat soreness or temporary reflux. Most people return to their normal activities, including being able to eat comfortably, within a week or two after their POEM surgery. Your Penn Medicine care team will guide you through each step of recovery and check your progress to help you return to eating normally.

Dealing with a condition that makes swallowing difficult can be frustrating. Finding an expert care team that understands your challenges is the first step toward relief. Penn Medicine specialists perform a high number of advanced endoscopic treatments, giving us deep expertise in treating conditions like achalasia. This experience is strengthened by a team-based approach that brings together experts in gastroenterology, surgery, nutrition, and swallowing therapy to provide complete care.