**Peroral Endoscopic Myotomy (POEM)** is a revolutionary, incisionless endoscopic procedure that offers a highly effective treatment for achalasia and other complex esophageal motility disorders. Unlike traditional surgery, POEM is performed entirely through the mouth, leaving no external scars and allowing for faster recovery.

What is Achalasia?

Achalasia is a rare, chronic disorder that affects the esophagus, the tube that carries food from your mouth to your stomach. In achalasia, the lower esophageal sphincter (LES)—a ring of muscle at the junction of the esophagus and stomach—fails to relax properly, and the esophageal muscles do not contract effectively to push food down. This leads to difficulty swallowing (dysphagia), regurgitation of undigested food, chest pain, and weight loss.

How Does POEM Work for Achalasia and Other Spastic Disorders?

POEM directly addresses the underlying problem in achalasia and similar conditions (like diffuse esophageal spasm or jackhammer esophagus) by cutting the tight muscles of the esophagus and/or the LES. This 'myotomy' relieves the obstruction and allows food and liquids to pass more easily into the stomach. Because it's an endoscopic procedure, Dr. Neeraj Dhar can perform it with remarkable precision, tailoring the myotomy to the specific needs of each patient.

Indications for POEM:

• Achalasia: All types of achalasia (Type I, II, III).
• Esophageal Spasm: Diffuse esophageal spasm, jackhammer esophagus, and nutcracker esophagus (when severe and unresponsive to other treatments).
• Patients who are not suitable for or prefer a less invasive alternative to traditional Heller myotomy surgery.

Advantages of POEM:

• **Minimally Invasive:** No external incisions, meaning no visible scars.
• **Faster Recovery:** Patients typically experience less pain and a quicker return to normal activities compared to open or laparoscopic surgery.
• **Highly Effective:** Demonstrates excellent success rates in relieving dysphagia and improving quality of life.
• **Versatile:** Can be tailored to the specific length and pattern of muscle dysfunction in various motility disorders.

Preparation for the Procedure:

• You will typically need to fast for 24-48 hours prior to POEM, often starting with a clear liquid diet.
• Thorough esophageal cleansing is essential to ensure a clear field of view and reduce infection risk.
• All medications, especially blood thinners, must be reviewed and adjusted by Dr. Dhar well in advance.
• General anesthesia is used, so you must arrange for someone to drive you home.

What to Expect During the POEM Procedure:

• The procedure is performed under general anesthesia.
• Dr. Dhar inserts a flexible endoscope through your mouth into the esophagus.
• A small incision (about 1-2 cm) is made in the inner lining (mucosa) of the esophagus.
• A tunnel is then created in the submucosal layer (just beneath the mucosa) extending down to and past the lower esophageal sphincter.
• Using specialized endoscopic tools, Dr. Dhar carefully cuts the inner circular muscle fibers (and sometimes the outer longitudinal fibers) of the esophagus and LES, relieving the muscle constriction.
• After the myotomy, the initial mucosal incision is closed with endoscopic clips, leaving the external esophagus intact.
• The procedure typically takes 1-2 hours.

Recovery and Post-Procedure Care:

• Patients usually stay in the hospital for 1-3 days for observation.
• You will start with a liquid diet and gradually advance to soft foods over a few days to weeks, as advised by Dr. Dhar.
• Mild chest discomfort or sore throat is common initially.
• Monitoring for potential complications like bleeding or perforation is crucial. Reflux symptoms after POEM are common and typically managed with medication.

Why Choose Dr. Neeraj Dhar for POEM?

Dr. Neeraj Dhar is among the few highly skilled gastroenterologists in Faridabad and the region proficient in performing advanced endoscopic procedures like POEM. His expertise in diagnostic motility testing (Esophageal Manometry) combined with his specialized training in therapeutic endoscopy ensures precise patient selection and optimal procedural outcomes. Dr. Dhar's commitment to adopting cutting-edge techniques provides patients with severe swallowing disorders a safe, effective, and minimally invasive path to relief and improved quality of life.

If you are suffering from achalasia or similar esophageal motility disorders, consult Dr. Neeraj Dhar to explore if POEM is the right treatment option for you.