POEM Surgery for Achalasia

Posted by evgenimat @evgenimat, Jan 8, 2018

Hi everyone,
I’ve had achalasia that progressively got worse over the course of three years, to the point where I almost couldn’t eat without throwing up, and drank at least a liter of water with every meal. I just had a POEM surgery done in November (2017) with Dr. Robert Bechara in Kingston, Ontario. I wanted share my experience because, like many people here, before my surgery I scoured the web for hours trying to get an idea of what I should expect. I ended up being very anxious about the surgery, afraid that it wouldn’t work or even make things worse. I now know I fell victim to confirmation bias, since people are much more likely to post a bad experience rather than a good one, and I want to dilute that a bit.
Like many, I was first diagnosed with GERD and took Proton Pump Inhibitors, which obviously didn’t work. After a barium swallow, endoscopy, and mamotomy (ugh), I was correctly diagnosed with Type I achalasia and was lucky enough to be scheduled for POEM only three months later. Dr. Bechara and his staff were incredibly friendly, communicative, and accommodating to the fact that I lived out of province. Dr. Bechara studied in Japan, where the procedure was developed, and had a success rate of 100% from 100 patients that he’d done the operation on. Contrasting to how nervous I was, he seemed to almost be bored. In fact, the day I had my operation, he had another person getting it too. So, he’s a total expert. Do ask your doctor how many operations they’d done and if they had any complications, if nothing else it’ll put your mind at ease.
Three days before the operation I was on a fully liquid diet, which isn’t bad but really drains your energy. All I wanted to do was lay in bed and watch TV, so don’t plan any marathons. The morning of the surgery I was put on IV and right before the surgery I was knocked out and put on anaesthetic. All I remember is the count down, and the next thing I knew I was coming to in the post-op room. At first the anaesthetic was still working so I felt sleepy but great. As it wore off though, I started feeling a pain in my chest. Getting up was out of the question for at least a few hours, but they gave me a fantastic pink numbing liquid (Lidodan 2%) which worked wonders. I was pretty much bedridden for the next three days, and had almost no energy for anything. So take that week off work is my advice.
This pain remained for about three weeks, and, I’ll be honest, it really sucked. At first it was a constant dull pain that inhibited my breadth of movement and would only be subdued by the pink stuff. After about a week the pain became acute, which was worse. I would feel almost totally fine, and then this sharp stab would suddenly come on and I had to lie down wherever I was; always have your pink stuff (or Tylenol) on hand. I thought these was the spasms some people wrote about in blogs and was afraid it wouldn’t go ever away. I definitely had thoughts that this wasn’t worth it, and I should’ve just lived with the swallowing issues rather than inhibiting spasms. BUT, the pink liquid was awesome and it would calm the pain in about 30 minutes, and it did go away after three weeks. It became less and less frequent, and now totally gone. The pain is not that surprising really, they put a 17cm incision inside your body – its gonna hurt. After a week after the surgery I was able to work just fine.
Right now, two months post-surgery, I feel so incredibly grateful that I had the operation done. I can eat all my favourite food not only without throwing up, but with consuming only a small amount of water (often not even necessary). I’ve started feeling thirsty again, can eat until I’m full, and have finally started regaining the weight I’d lost. If you have a chance to do this operation, do it. And I would highly recommend Dr. Bechara if you have the opportunity. Good luck, and don’t give up hope!

Interested in more discussions like this? Go to the Digestive Health Support Group.

How are you doing a year later?

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@jenniferb

@margaretmary Hey Margaret! He did not have any other procedures. As soon as he was properly diagnosed, his POEM was scheduled 8 weeks later. By the time he went in, it was so bad that even water was causing bad pain. It was even coming back up. The day after his surgery, they did the swallow test. There were no leaks. The Barium went down, but not all of it. Some of it sat there still. However, the doctor said my husband's esophagus had a twisted shape now, due to the advanced state of Achalasia. This is his 3rd day after surgery. He is able to get down liquids, without any coming back up. However, he got pain with a smoothie (no chunks). He doesn't know if it is due to the surgery site, or if stuff was beginning to back up again. He did say it felt like it was backing up. We are so worried it didn't work.

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I had pain with a smoothie as well on day 4. I was afraid it was too thick. The pain when swallowing has not gone away now. I’m taking extra strength Tylenol which helps some.

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@dstb83bb

I thought I was home free because the first 3 days I had very little pain. However the next day the pain started when I swallowed and sometimes just moving the wrong way. I was afraid I might have knocked a clip loose until reading about others pain here

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I doubt it’s a clip issue. You would have to do something extreme for that to happen. I work in the fitness industry and I was precluded from abdominal crunches and heavy weights (which I really don’t do very heavy) for five weeks post op. I think you are just healing. That’s why the post op diet is so limited so as to allow for healing time. I hope each day is a little better.

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Thank you for the reassurance!

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@dstb83bb

@jenniferb my heart aches for your husband. I am 63 and have suffered for years. When I was in my 30’s I stopped swallowing- lost 30 pounds in one month. The doctors all told me it was in my head because they could see nothing wrong with my throat - no tests were done! Thank goodness for medical advances. I was diagnosed with jackhammer esophagus this go round. I had the POEM procedure last week. 3 days post op I thought I was home free. Not the case now! The pain is pretty bad when I swallow! But I can feel a difference in my chest - I am hopeful no more esophageal spasms. I am going to add your husband to my prayer list. I know how difficult it can be.

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Thank you. All prayers are appreciated. After speaking with Margaret on here, and continuing to do more research, we are going to another practice. Unfortunately, even since two days ago, my husband is having food stuck and regurgitation again. He has shown signs of improvement, but not what was expected. One issue, we believe, is that the myotomy was only cut at 6cm. With his advanced state of Achalasia, it should have been much more. We are remaining hopeful that something else can be done.

Thank you for your prayers.

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I will say though, my husband is not having spasms any more. At least he isn't right now. He is a little over 2 weeks post op. He had a decent amount of pain after the surgery. We are thinking that was because of the surgery, not the Achalasia itself. However, he also is having the chest pressure and regurgitation again. If you do not have that, you are probably having a good recovery.

You also, will be in our prayers. Keep me updated.

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@dstb83bb

@jenniferb my heart aches for your husband. I am 63 and have suffered for years. When I was in my 30’s I stopped swallowing- lost 30 pounds in one month. The doctors all told me it was in my head because they could see nothing wrong with my throat - no tests were done! Thank goodness for medical advances. I was diagnosed with jackhammer esophagus this go round. I had the POEM procedure last week. 3 days post op I thought I was home free. Not the case now! The pain is pretty bad when I swallow! But I can feel a difference in my chest - I am hopeful no more esophageal spasms. I am going to add your husband to my prayer list. I know how difficult it can be.

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Hello dstb83bb. Thank you for your post ...I am just wondering how are you doing now ??? I have Jackhammer oesophagus and achalasia type 111 , and will be having P.O.E.M quite soon . I am, frankly terrified. I have been advised that my eosophogus will be paralysed after surgery, and that this is irreversible . I’m worried that I will have the surgery, and the spasms will still be there , and nothing has changed , other than the fact my oesophagus will be paralysed . I can’t even begin to think about what that might feel like ....I would love to have a discussion with you ????

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@dstb83bb

@jenniferb my heart aches for your husband. I am 63 and have suffered for years. When I was in my 30’s I stopped swallowing- lost 30 pounds in one month. The doctors all told me it was in my head because they could see nothing wrong with my throat - no tests were done! Thank goodness for medical advances. I was diagnosed with jackhammer esophagus this go round. I had the POEM procedure last week. 3 days post op I thought I was home free. Not the case now! The pain is pretty bad when I swallow! But I can feel a difference in my chest - I am hopeful no more esophageal spasms. I am going to add your husband to my prayer list. I know how difficult it can be.

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Hello ...I have sent you a private message .. I do hope you’re well now, and as I am about to have the P.O.E.M, I would love to chat with you ???

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@franduffy

Hello ...I have sent you a private message .. I do hope you’re well now, and as I am about to have the P.O.E.M, I would love to chat with you ???

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Hi this is Margaret. I saw your previous post but I thought you were asking to communicate with Jenn whose husband had a POEM with some post op issues. I too had the procedure in January. If you have any questions I’d be happy to tell you about my experience.

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@margaretmary

Hi this is Margaret. I saw your previous post but I thought you were asking to communicate with Jenn whose husband had a POEM with some post op issues. I too had the procedure in January. If you have any questions I’d be happy to tell you about my experience.

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Thank you Margaret .. firstly , I have Jackhammer oesophagus, as well as achalasia type 111, I just wondered if there’s a big difference in the feeling you have in your chest once you've had the procedure.??? I’m just worried that I would be aware of my oesophagus being unable to function properly. I’m having an extended P.O.E.M , where the doc will cut the muscle at the bottom and cut all the way up the oesophagus also. I’m quite frightened of the after effects . How are you feeling now ?... I do hope all is well !

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