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.

Hi @patriciashort,

Welcome to Connect. Here is some detailed information about peroral endoscopic myotomy (POEM): https://www.uptodate.com/contents/peroral-endoscopic-myotomy-poem

I’m tagging a few fellow members who have talked about reflux, achalasia and POEM – please meet @craig7 @dandl48 @ed32 @ed_85 and @kozlo52 – I hope they will be able to offer more insight.

@margaretmary asks a very good question; typically POEM has been endorsed as a primary treatment for type I and II achalasia, but it is increasingly being used to treat other gut disorders as well. May I ask if you’ve tried other therapies to relieve the GERD?

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Profile picture for patriciashort @patriciashort

My gastro dr is recommending I get POEM surgery due to the issues I have. I am scared. I don't have weight issues nor do I have swallowing issues. I have gerd pretty bad and if I lay down my food comes back up. Stuff like that. Having read some reviews for after surgery makes me even more hesitant. Pain for example and months of it. How long does pain last? Will I always be on a soft diet? Any information you can supply me with will really be helpful

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@patriciashort I have never had the surgery so cannot answer your questions. I would suggest you do a search of this site using the search function.. it looks like a small magnifying glass up above this post to the left of where the word APPOINTMENT is. There are several discussions about it.

In my opinion if you are not comfortable with your gastro doctor's recommendation of having POEM surgery I would get a second opinion.

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My gastro dr is recommending I get POEM surgery due to the issues I have. I am scared. I don't have weight issues nor do I have swallowing issues. I have gerd pretty bad and if I lay down my food comes back up. Stuff like that. Having read some reviews for after surgery makes me even more hesitant. Pain for example and months of it. How long does pain last? Will I always be on a soft diet? Any information you can supply me with will really be helpful

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Profile picture for patriciashort @patriciashort

I am getting ready to possibly have the surgery and I am quite afraid. While I don't have what I consider swallowing issues I do have severe G.E.R.D. If I lay down sometimes my food comes right back up. I have terrible heartburn almost all the time. I have found out that flour is really my enemy. The main reason I am so afraid about the surgery is that they might not correct the issue and the pain afterwards. I have read so many reviews and none have been that good. Any assurances would be great. Some positive feedback would really help me. Any good advice also.

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Hi Patricia:
Have you been diagnosed with achalasia and is the procedure you are having a POEM?
Margaret

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I am getting ready to possibly have the surgery and I am quite afraid. While I don't have what I consider swallowing issues I do have severe G.E.R.D. If I lay down sometimes my food comes right back up. I have terrible heartburn almost all the time. I have found out that flour is really my enemy. The main reason I am so afraid about the surgery is that they might not correct the issue and the pain afterwards. I have read so many reviews and none have been that good. Any assurances would be great. Some positive feedback would really help me. Any good advice also.

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Happy new year and it seems it will be a healthy one as well. So glad you are starting to feel positive results from the procedure. Continued good luck.

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Happy New Year to all, a very prosperous and healthy 2020! Just as an update, I am starting to finally see some real improvement on my condition, it looks like POEM did wonders to me after all. I still feel some fatigue on my throat when swallowing but no more that feeling of food getting stuck on my throat or for food to go down. No signs yet of reflux, hopefully, that continues.

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Profile picture for addiquijote @addiquijote

Hi Margaret, thanks for writing. I was put on a clear liquid diet for a full week, that was very hard. This coming Monday it will be 4 weeks since my surgery, up to last Tuesday I actually was feeling worse after the procedure when eating, basically, everything I ate felt like it got stuck on my throat. Since Wednesday, I have been feeling some improvement, it is not back to normal but it does feel better, hopefully it will keep improving little by little. Good luck to you, cheers and I will keep you all posted!

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Slow but sure improvement for you and I am happy to hear you are headed in the right direction. Keep us “POEM People” posted. Happy holidays and a healthy new year to all. Margaret

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Profile picture for margaretmary @margaretmary

I was on a clear liquid diet the first three days post op followed by full liquid for the next three and then solids. I noticed swallowing improvement fairly quickly but as I said before it can take time. You are still healing. As for the food getting stuck that was constant prior to the procedure. So uncomfortable as I’m sure you know. I had to drink inordinate amounts of water to complete a meal. I hope you continue to progress. Be well.

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Hi Margaret, thanks for writing. I was put on a clear liquid diet for a full week, that was very hard. This coming Monday it will be 4 weeks since my surgery, up to last Tuesday I actually was feeling worse after the procedure when eating, basically, everything I ate felt like it got stuck on my throat. Since Wednesday, I have been feeling some improvement, it is not back to normal but it does feel better, hopefully it will keep improving little by little. Good luck to you, cheers and I will keep you all posted!

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Profile picture for addiquijote @addiquijote

Hello, thanks for your reply. I am that your PEOM surgery went well, sorry to hear about the reflux but, as you mentioned, it is one of the side effects of the surgery. Yeah, I will definitely try to slow down and stick to soft solid food as much as possible. How long after your surgery did you notice an improvement? I guess that is my main concern, just not knowing how long it will take for things to get back to normal. I spoke to my surgeon about my issue last Wednesday and he said that it usually takes time to it to improve. I will have to wait and see, hoping that the surgery was worth it, I am already looking at what other options may be out there if this does not work. I only had surgery on the LES, wonder if there is a need to expand the surgery, I guess only time will tell. Good luck to you as well keep us posted. Ah, one more question for you, was the feeling of food stuck in your throat one of your symptoms prior to surgery?

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I was on a clear liquid diet the first three days post op followed by full liquid for the next three and then solids. I noticed swallowing improvement fairly quickly but as I said before it can take time. You are still healing. As for the food getting stuck that was constant prior to the procedure. So uncomfortable as I’m sure you know. I had to drink inordinate amounts of water to complete a meal. I hope you continue to progress. Be well.

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