- Swallowing is a markedly complex maneuver.
There's many motions and muscles that are involved in coordinating the initial swallow
to get the food in the esophagus and bypass the windpipe.
- So those muscles have to work correctly
and the sphincter at the upper end of the esophagus has to open.
Once the food gets into the esophagus,
it needs to be transported from the top of the esophagus to the stomach.
- There's a muscle tract throughout the whole intestinal tract
that coordinates sort of a motion to kind of squeeze
the food down the intestinal tract.
- In most of us, this just works normally.
It's involuntary control.
You don't actually think about swallowing.
It happens automatically.
If you have difficulty swallowing, it's going to have a major impact on your life.
Difficulty swallowing has a host of reasons.
Achalasia is considered
a disease of swallowing or a motility disease
where there's degeneration for an unknown reason of the cells
that control the muscles of the swallowing tube, resulting in two major abnormalities.
The lower esophagus sphincter does not relax,
so if it doesn't relax, food cannot pass into the stomach
and the second thing is that the esophagus body doesn't contract to push the food down
and the combination of both of these abnormalities
results in food getting stuck in the esophagus.
- We have some medications, but not a great deal of medications for these kinds of problems.
- The underlying disease in Achalasia is degeneration of the nerves.
We don't have a cure.
We cannot make the nerves regrow
and so all we can do is something mechanical to help swallowing.
- By performing a myotomy, which is a cutting of that circular muscle
so it can't clamp down when the food is trying to get through,
that can significantly improve swallowing and Achalasia.
- Most recently, an endoscopic procedure has been developed to perform
the same treatment that a surgeon would perform,
which is cutting the lower esophageal sphincter,
but doing it in a very minimally invasive fashion through an endoscope.
There are no incisions in the skin.
There are no incisions in the abdomen.
- We're able to access that muscle by temporarily passing the scope
through the middle layers of the esophagus and we can cut that muscle
and then remove the scope and then close up the small opening
we use to reach the muscle layer inside the esophagus.
- The recovery, based on clinical studies, is very quick.
It requires perhaps an overnight admission at the most.
Based on the very successful application of the POEM procedure
to Achalasia patients and the outcomes that we and others have witnessed with our patients
our indications for POEM procedure have now expanded
and they have multiple other esophageal motility disorders
that are starting to be treated by a POEM procedure.
and this is expanding to other parts of the gut.
- We're fortunate to work with a highly skilled, multidisciplinary team with experts in diagnosis
and management of motility disorders like Achalasia and Gastroparesis,
as well as a team of very highly skilled laparoscopic surgeons.
So when we encounter a problem with a patient,
we work as a team to make sure we have the correct diagnosis.
Look at your symptoms and how we can improve your quality of life
by determining what approach would work best for that individual patient.