POEM Treatment in Delhi – Dr. Hitendra K. Garg Finding it difficult to swallow food or feeling that food gets stuck in your chest? These symptoms may sometimes be caused by a condition called achalasia , in which the food pipe (oesophagus) does not move food into the stomach properly. For selected patients with achalasia, POEM (Peroral Endoscopic Myotomy) is a minimally invasive treatment option. The procedure is performed through the mouth using an endoscope, without making external cuts on the abdomen or chest. Dr. Hitendra K. Garg, Senior Consultant Gastroenterologist, Hepatologist and Therapeutic Endoscopist at Indraprastha Apollo Hospitals, New Delhi, provides evaluation and treatment for a range of digestive conditions. If you are exploring POEM treatment in Delhi , understanding the condition, available treatment options and the procedure can help you make an informed decision. What Is POEM Treatment? POEM stands for Peroral Endoscopic Myotomy. It is an advanced endoscopic procedure used mainly to treat achalasia. In achalasia, the lower oesophageal sphincter (LES) does not relax properly when food reaches the lower end of the food pipe. The normal movement of the oesophagus may also become weak or absent. As a result, food and liquids can have difficulty passing in to the stomach. During POEM, a doctor uses a flexible endoscope to reach the affected area through the mouth. A small tunnel is created inside the oesophageal wall, and selected muscle fibres are cut to help food pass more easily into the stomach. Unlike traditional surgery, POEM does not require external abdominal or chest incisions. What Is Achalasia and Why Does It Affect Swallowing? Achalasia is a disorder of the oesophagus, the muscular tube that carries food from the mouth to the stomach. Normally, the oesophagus moves food down through coordinated muscle contractions. At the same time, the lower oesophageal sphincter relaxes to allow food to enter the stomach. In achalasia, this process does not work properly. The lower oesophageal sphincter remains tight, and the normal movement of the food pipe is affected. Common symptoms include: • Difficulty swallowing solid food and liquids • Feeling that food gets stuck in the chest • Regurgitation of undigested food • Chest discomfort or pain • Frequent coughing, particularly at night • Unexplained weight loss • Heartburn - like symptoms These symptoms can also occur in other digestive conditions. Proper testing is important before deciding on treatment. When Is POEM Treatment Recommended? POEM may be considered for patients diagnosed with achalasia, particularly when the symptoms affect eating, swallowing and everyday life. A gastroenterologist may discuss POEM when: • Achalasia has been confirmed through appropriate tests. • Swallowing difficulties are affecting daily activities. • The lower oesophageal sphincter is not relaxing properly. • The patient is suitable for an endoscopic myotomy. • Other treatment options have been discussed. POEM may also be considered for selected patients with Type III achalasia. However, the most appropriate treatment depends on the type of achalasia, test findings, medical history and overall health. Not every patient with swallowing difficulty needs POEM. How Is POEM Treatment Performed? POEM is performed using a flexible endoscope passed through the mouth. The patient is generally under general anaesthesia during the procedure. The main steps include: 1. Endoscope Insertion The doctor gently passes the endoscope through the mouth into the oesophagus to reach the affected area. 2. Creating a Small Entry A small opening is made in the inner lining of the oesophagus to access the muscle layer. 3. Creating a Tunnel A tunnel is carefully created within the oesophageal wall to reach the lower oesophageal sphincter. 4. Muscle Cutting (Myotomy) Selected muscle fibres are cut to reduce the tightness of the lower oesophageal sphincter and help food pass into the stomach. 5. Closing the Entry The small opening in the inner lining is closed using endoscopic clips. The procedure is completed internally, without external surgical cuts. What Are the Benefits of POEM? For appropriately selected patients, POEM can help improve swallowing and reduce symptoms caused by achalasia. Some potential benefits include: • No external abdominal or chest incision • Treatment through the mouth using an endoscope • Relief from difficulty swallowing in many patients • Can be considered for different types of achalasia • May be suitable for selected patients who have had previous treatment However, POEM is not free from risks. Possible complications include bleeding, infection, injury or leakage, and acid reflux after the procedure. The expected benefits and risks should be discussed with the treating specialist. POEM vs Heller Myotomy: What Is the Difference? POEM and Heller Myotomy are two established procedures used to treat achalasia. Both aim to relax the lower oesophageal sphincter so that food can pass more easily into the stomach. POEM (Peroral Endoscopic Myotomy) • Performed through the mouth using an endoscope. • No external surgical incision is required. • The doctor cuts selected muscle fibres in the oesophagus. • It may be considered for different achalasia subtypes, including selected Type III cases. Heller Myotomy • Performed using a laparoscopic surgical approach in most cases. • Involves small incisions in the abdomen. • The surgeon cuts the tight muscle fibres of the lower oesophageal sphincter. • A partial fundoplication may also be performed to help reduce acid reflux. Neither procedure is automatically the right choice for every patient. The decision depends on the achalasia type, reflux risk, previous treatment and the patient's overall condition. Tests Required Before POEM Treatment Before recommending POEM, the doctor needs to confirm the diagnosis and understand how the oesophagus is functioning. The evaluation may include: 1. High - Resolution Oesophageal Manometry This test measures muscle contractions and pressure inside the oesophagus. It plays a key role in confirming achalasia and identifying its type. 2. Barium Swallow Test The patient drinks a contrast liquid while X - ray images are taken. The images help show how the liquid moves through the oesophagus and whether it is narrowing or retaining food and fluid. 3. Upper GI Endoscopy A thin, flexible camera is passed through the mouth to examine the oesophagus and stomach. It helps identify abnormalities and rule out other possible causes of swallowing difficulty. The tests required depend on the patient's symptoms and medical history. Recovery After POEM Treatment Recovery varies from one patient to another. After the procedure, the medical team monitors the patient and checks for any immediate complications. The doctor may recommend: • Following a liquid or soft - food diet for a specific period. • Gradually returning to normal food as advised. • Taking prescribed medicines, including acid - suppressing medication when recommended. • Attending follow - up appointments. • Reporting new or worsening symptoms promptly. Diet instructions and follow - up schedules should always be based on the treating doctor's advice. Why Consult Dr. Hitendra K. Garg for POEM Treatment in Delhi? Dr. Hitendra K. Garg is a Senior Consultant Gastroenterologist, Hepatologist and Therapeutic Endoscopist at Indraprastha Apollo Hospitals, New Delhi. His qualifications include: • DM in Gastroenterology – G.B. Pant Hospital • MD in Medicine – Banaras Hindu University • MBBS – Banaras Hindu University Evaluation for achalasia involves understanding the patient's symptoms, reviewing diagnostic test results and assessing the most suitable treatment approach. Patients considering POEM can discuss their diagnosis, treatment options, expected outcomes and possible risks with a qualified specialist. When Should You Consult a Gastroenterologist? Do not ignore swallowing difficulties, particularly when they continue or become worse. Consider consulting a gastroenterologist if you experience: • Difficulty swallowing food or liquids • Food repeatedly getting stuck in the chest • Frequent regurgitation • Unexplained weight loss • Repeated coughing or choking while eating • Persistent chest discomfort associated with swallowing Seek urgent medical attention if you are unable to swallow liquids or saliva, have breathing difficulties or experience severe chest pain. Early evaluation can help identify the cause and determine the appropriate treatment. Conclusion Difficulty swallowing should not be treated as an ordinary digestive problem when it keeps happening. Achalasia can affect the normal movement of food through the oesophagus, but treatment options are available. POEM treatment in Delhi may be an option for selected patients with achalasia. The procedure uses an endoscope passed through the mouth to relax the tight muscles of the lower oesophageal sphincter, without external surgical incisions. Dr. Hitendra K. Garg at Indraprastha Apollo Hospitals, New Delhi, provides evaluation and care for digestive conditions, including advanced endoscopic procedures. If you are experiencing persistent swallowing difficulties, consult a gastroenterologist to understand the cause and discuss suitable treatment options. Learn more or request an appointment: https://drhitendrakgarg.com/ Contact: +91 89206 32657 | +91 89203 61841 Hospital: Indraprastha Apollo Hospitals, NH - 19, Sarita Vihar, New Delhi 110076 Disclaimer: This article is for general educational purposes only. It does not replace professional medical advice, diagnosis or treatment. The suitability of POEM depends on individual clinical assessment.