Per Oral Endoscopic Myotomy (POEM)
Achalasia
Achalasia is a condition in which the lower oesophageal sphincter, the ring of muscle at the bottom of the oesophagus that opens to allow food to pass into the stomach, fails to relax properly during swallowing. This occurs because of a gradual loss of the nerve cells that control the oesophageal muscles. As a result, the normal wave-like contractions that push food downwards are lost, and food and liquid build up in the oesophagus, which can slowly become stretched and enlarged over time.
Although it is uncommon, achalasia can occur at any age, but it is most often diagnosed between the ages of 25 and 60 and affects men and women equally. Symptoms usually develop gradually and worsen over time. Patients may experience difficulty swallowing both solids and liquids (dysphagia), regurgitation of undigested food, chest pain or discomfort behind the sternum, heartburn, unintended weight loss, and night-time coughing or aspiration. Some patients also find they need to drink water, stand up or arch their back to help food pass.
Diagnosis is usually confirmed with high-resolution oesophageal manometry, which measures the pressures within the oesophagus. A barium swallow X-ray and an endoscopy are also done to exclude other causes. Early identification is important, as the condition can affect nutrition, swallowing safety, and quality of life.
POEM procedure
Per-Oral Endoscopic Myotomy (POEM) is a modern, minimally invasive endoscopic treatment for achalasia. Unlike traditional keyhole (laparoscopic) Heller myotomy, POEM is performed entirely through the mouth using a flexible endoscope, with no external cuts or incisions required.
During the procedure, a small tunnel is created beneath the lining of the oesophagus, extending down past the junction with the stomach, to reach the tight muscle of the lower oesophageal sphincter. This muscle is then precisely divided, allowing swallowed food and liquid to pass freely into the stomach. The entry point in the lining is closed with small clips at the end of the procedure.
At Riverview Endoscopy, Dr Niroshan Muwanwella performs POEM using the latest high-definition endoscopic equipment and advanced submucosal dissection techniques. He is one of the few endoscopists in Western Australia with extensive training and experience in third-space endoscopy, including POEM for achalasia, Z-POEM for Zenker’s diverticulum, and G-POEM for gastroparesis.
Most patients experience rapid symptom relief and minimal post-procedure discomfort. They usually begin drinking fluids the same day after the procedure and move to a soft diet over the following one to two weeks. POEM also allows the length of the muscle division to be tailored to each patient using EndoFLIP® only available at Riverveiw Endoscopy, and its long-term results are comparable to those of surgery.
At Riverview Endoscopy, each case is carefully reviewed in collaboration with anaesthetists and radiology specialists to ensure optimal safety and outcomes.
What to Expect with Z-POEM
Before the procedure:
Patients will have a consultation to review medical history, swallowing symptoms, and previous investigations such as a barium swallow or endoscopy. You’ll receive specific fasting and medication instructions prior to the procedure. Z-POEM is usually performed under general anaesthesia, ensuring you are completely comfortable throughout.
During the procedure:
The endoscope is introduced through the mouth—no incisions are made. A small tunnel is created under the lining of the upper oesophagus, allowing precise access to the abnormal cricopharyngeal muscle. This muscle is carefully divided using advanced electrosurgical instruments, typically taking 30–60 minutes depending on the size of the diverticulum.
After the procedure:
You’ll be observed in hospital, usually for one night, to ensure full recovery and to monitor for any complications such as mild throat discomfort or temporary difficulty swallowing. Most patients can resume a fluid diet the same day and return to normal activities within a few days. Follow-up endoscopy or imaging may be arranged to confirm complete healing and long-term success.
At Riverview Endoscopy, we prioritise patient safety, comfort, and comprehensive aftercare to ensure optimal outcomes following POEM.