video: University Hospitals Case Medical Center in Cleveland, OH, is one of five institutions nationwide performing a novel scarless procedure that restores swallowing function in some patients with achalasia, a rare condition where the esophagus is unable to move food into the stomach. Per-oral endoscopic myotomy (POEM) is a state-of-the-art technique to treat patients without any external incisions or outside scars. view more
Credit: Jennifer Guerrieri, University Hospitals Case Medial Center News Service
CLEVELAND – University Hospitals (UH) Case Medical Center is one of five institutions nationwide performing a novel scarless procedure that restores swallowing function in some patients with achalasia, a rare condition where the esophagus is unable to move food into the stomach. Per-oral endoscopic myotomy (POEM) is a state-of-the-art technique to treat patients without any external incisions or outside scars. With POEM, surgeons enter through the mouth and tunnel an endoscope down the esophagus to cut the muscle fibers to open the esophagus, allowing food to enter the stomach.
"The POEM procedure provides a more minimally invasive approach to achalasia that will help patients recover more quickly," says Jeffrey L. Ponsky, MD, Chairman of the Department of Surgery at UH Case Medical Center and Case Western Reserve University School of Medicine. "This leading-edge surgery is the way of the future."
UH Case Medical Center has successfully performed 15 POEM surgeries and continues to enroll appropriate candidates into a clinical trial of POEM. About 700 POEM procedures have been done worldwide, estimates Jeffrey Marks, MD, Director, Surgical Endoscopy, UH Case Medical Center; and Professor, Case Western Reserve University School of Medicine.
The POEM procedure was developed two years ago in Japan, using refined technologies and approaches learned from natural orifice translumenal endoscopic surgery (NOTES). NOTES is a technique to remove organs using the body's natural orifices as an entry point.
While the scarless procedure is being pioneered in patients with achalasia, this approach has potential applications for multiple other gastrointestinal diseases. Tunneling techniques like those used in POEM and NOTES are developing rapidly as surgeons see that they are well-tolerated by the body. To view a video about POEM, go to: http://www.youtube.com/watch?v=c77z7Yh8hfs
"As we continue to learn about tunneling techniques and develop new tools, we're increasingly optimistic about what this means for the future of surgery," says Dr. Marks, who likened POEM to the advent of laparoscopic surgery. "Within the last two decades, laparoscopy transitioned from a revolutionary medical advancement to a commonplace procedure. We're hopeful that in the future we can apply methods like POEM to other areas."
More than 3,000 people are diagnosed with achalasia each year. The most common symptom is difficulty swallowing. Because patients have trouble eating and drinking, achalasia can lead to unintentional weight loss and malnutrition.
Traditional methods to treat achalasia include pharmacologic therapy, surgical therapy and endoscopy therapy. Surgical cure initially was done with a procedure called a Heller myotomy. In recent years, surgeons have performed the procedure laparoscopically, with about five small incisions in the abdomen.
POEM provides a number of benefits over traditional treatment methods, including faster patient recovery, the ability to avoid abdominal surgery and outside scarring, a potential reduced risk of reflux problems, a decreased chance of disrupting other tissues and greater surgical precision. It is a particularly beneficial approach for patients who would be more of a challenge to treat surgically because of prior esophageal or stomach operations or for patients who are morbidly obese.
About University Hospitals
University Hospitals serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians. At the core of our health system is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked among the top children's hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center at Case Western Reserve University. University Hospitals Case Medical Center is the 2012 recipient of the American Hospital Association – McKesson Quest for Quality Prize for its leadership and innovation in quality improvement and safety. For more information, go to www.uhhospitals.org