Advanced Treatments for Esophageal-Gastric Motility Disorders and Gastrointestinal Tumors
The Orlando Health Digestive Health Institute offers qualifying patients advanced treatment options including peroral endoscopic myotomy (POEM) for esophagus or gastric dysmotility and submucosal tunneling endoscopic resection (STER).
POEM is a minimally invasive endoscopic procedure used to treat achalasia cardia — a disease that affects the muscle layer of the esophagus. With achalasia cardia, food and liquid move more slowly into the stomach, causing a sensation of having food stuck in the esophagus, or pain or fullness in the chest. With severe disease, patients can aspirate the fluid into the lungs, which can result in pneumonia. POEM offers patients an effective treatment option with a much quicker recovery than standard surgery.
STER is a procedure to remove tumors from the deep layers of the gastrointestinal tract, particularly the esophagus and stomach. Like POEM, STER is a similarly effective treatment option with quicker recovery times than surgery.
In a POEM procedure, your endoscopist will guide a thin, flexible tube called an endoscope through your mouth and into your esophagus. Through the endoscope, a specifically formulated solution is injected into the deep tissue layers of the esophagus. This will lift the upper mucosal layer and peel it away from the deeper muscle layer. Using a special knife attached to the endoscope, your endoscopist will first make a small tunnel inside the deep tissue layer of the esophagus and then make a thin cut in the muscle layer inside the tunnel. When treatment is completed, the incision site in the esophagus is closed with the use of clips.
Overall, the STER procedure is quite similar to POEM. Again, your endoscopist will insert an endoscope through your mouth and route it into the esophagus or stomach to the location of the tumor. After injection of the prepared solution into the deeper tissue layers, your endoscopist will use the special knife attached to the endoscope to make a small tunnel inside the deeper tissue layer of the esophagus or stomach. Once the tumor is visible, your endoscopist will use the knife to cut out the tumor, which is then removed via the endoscope.
Previously, surgery was the only available option for the treatment of achalasia cardia and the removal of benign tumors located in the deeper layers of the esophagus or stomach. This type of surgery usually requires a three- to seven-day inpatient stay at the hospital. POEM and STER often can be performed sooner and with only one or two days of hospitalization.
G-POEM is an endoscopic procedure used to treat gastroparesis, or delayed gastric emptying, which is a disorder that slows or stops the movement of food from your stomach to your small intestine. The G-POEM procedure is performed just like a standard POEM except that the incision in the muscle layers is made in the part of the stomach that opens into the small intestine (duodenum). This allows for better and faster emptying of the stomach. The general preparation, process and complication risks are the same as the POEM procedure.
On the day before your POEM or STEM procedure, you may have only clear liquids. For about six hours prior to the procedure, you cannot eat or drink anything (not even water). Your doctor will give you specific instructions on when to start fasting. If you do not precisely follow your doctor’s instructions, the procedure may have to be postponed.
Current Medications
Most medications can be taken as usual until the day of your procedure. Be sure to tell your doctor about all medications you are taking as well as any medication allergies that you may have. Anticoagulant medications (blood thinners) will have to be adjusted prior to the procedure. Aspirin and Warfarin (Coumadin) must be discontinued for five days before and five days after the procedure. Clopidogrel (Plavix) must be discontinued for seven days before and five days after the procedure. Please contact the doctor’s office with questions about any other types of blood thinners you are taking. Sometimes, written permission from your cardiologist or prescribing physician maybe required before stopping blood thinners or other medications.
POEM and STER procedures are performed under general anesthesia; you will receive intravenous (IV) sedatives to help you relax. The procedure will most likely start with you lying on your back. Once you are sedated, your endoscopist will pass the endoscope through your mouth and into the esophagus or stomach, depending on the kind of treatment you need. You will be able to continue to breathe normally with the endoscope in place. Most patients find it to be only slightly uncomfortable, and many fall asleep during the endoscopic procedure.
Since you are sedated for the procedure, you will be kept in the recovery area and monitored until effects of the medication have diminished. Your throat may feel a little irritated. You also may feel some pain in your chest or abdomen. This usually will subside with medication. You will not be allowed to eat or drink anything for the remainder of the day and night following the procedure. The morning after the procedure, you will receive an X-ray exam and will be allowed to begin a clear liquid diet. Over the next few days, your diet will gradually progress until returning to a normal diet usually after one to two weeks.
Normally, you will receive POEM and STER results the same day as the procedure. If you have a STER procedure, the lesion that was removed will be sent to pathology for microscopic evaluation. These results will be available in approximately five to seven days and will be sent to your referring doctor, who will determine if you need to schedule a follow-up appointment with them or with our office.
Occasionally, if a tumor is located very deep within the tissue, it cannot be removed endoscopically. This usually can only be discovered during the procedure. In this case, it will then be necessary for you and your referring doctor to decide on treatment alternatives.
Standard endoscopy is very safe. While rare, complications from endoscopic procedures can include:
- An adverse reaction to the sedative given (This is very rare but is a concern for patients with severe heart or lung disease.)
- A puncture or tear in the gastrointestinal tract that may require surgical repair (Perforation occurs in about one of every 200 to 300 cases.)
- Major bleeding in the gastrointestinal tract caused by the endoscopic procedure (This can develop even up to five days following the procedure.)
These possible risks must be weighed against the potential benefits of the POEM or STER procedure as well as the risks of alternative treatment options for your condition.
