POEM Procedure for Achalasia: What It Is and Why Patients in Secunderabad No Longer Need to Travel for Treatment
When food stops moving from your throat to your stomach — not because of a blockage you can see, but because a valve that should open simply refuses to — you're living with something that affects every single meal. Every sip of water. Every attempt at a normal dinner.
That's achalasia. And for a long time, treating it well meant travelling — to Chennai, Mumbai, or abroad — because the right procedure simply wasn't available locally.
That changed when POEM became available in this region. I was among the first ten surgeons to perform POEM in South India, and it remains one of the procedures I find most clinically rewarding — because the transformation in a patient's quality of life is immediate and durable.
What Is Achalasia?
The esophagus is a muscular tube that moves food from the mouth to the stomach. At its lower end sits a valve — the lower esophageal sphincter (LES) — that opens when you swallow, allowing food to pass into the stomach, then closes again to prevent reflux. In achalasia, the nerve cells that control this valve degenerate progressively. The sphincter stops relaxing properly. The coordinated muscular contractions that push food down the esophagus — called peristalsis — become abnormal or disappear entirely. Food backs up into the esophagus instead of passing through. Achalasia affects about 1 in 100,000 people. It is rare, which is exactly why it gets misdiagnosed for so long — typically as GERD, anxiety, or 'functional' symptoms. By the time many patients reach me, they've been on acid suppressants for years. The acid suppressants don't help, because achalasia has nothing to do with acid. It's a neuromuscular problem, not a chemical one.
How Is Achalasia Diagnosed?
Three investigations typically confirm the diagnosis:
High-Resolution Manometry (HRM)
A thin pressure-sensing tube is passed through the nose and positioned in the esophagus. It measures pressure patterns as you swallow. In achalasia, HRM shows a characteristic pattern — elevated resting pressure at the LES and absent or disordered peristalsis in the esophageal body. This is the gold standard test and gives the definitive diagnosis.
Barium Swallow X-ray
You swallow a barium solution and X-rays capture its passage through the esophagus. In achalasia, the classic image is a 'bird beak' or 'rat tail' narrowing at the lower end — the tight sphincter causing a characteristic tapering. This also shows how dilated the esophagus has become.
Upper GI Endoscopy
Primarily done to rule out other causes of swallowing difficulty — particularly tumours at the gastroesophageal junction that can mimic achalasia (called pseudo-achalasia). A normal-looking endoscopy does not rule out achalasia; you still need manometry.
What Was Available Before POEM?
For most of its history, achalasia had three treatment options:
• Botulinum toxin injection — injected into the LES to temporarily relax it. Effective for about 6–12 months, then wears off and must be repeated. Causes submucosal scarring that complicates any future procedure.
• Pneumatic balloon dilation — an endoscopically-guided balloon is inflated at the LES to forcefully stretch and partially tear the sphincter. Effective in a good proportion of patients but requires repeat procedures in many, and carries a small but real risk of esophageal perforation.
• Heller Myotomy — a laparoscopic surgical procedure where the LES muscles are cut through small abdominal incisions. Very effective, but it requires general anaesthesia, several incisions, a hospital stay, and a longer recovery.
POEM achieves the same result as Heller Myotomy — cutting the sphincter muscles — but without any incision in the skin.
What Is POEM?
POEM stands for Peroral Endoscopic Myotomy. 'Peroral' means through the mouth. 'Myotomy' means cutting the muscle. Everything happens through an endoscope passed down the throat — no skin is cut, no external wound is made.
Step by step, here is how the procedure works:
1. The patient is under general anaesthesia. An endoscope is passed through the mouth into the esophagus.
2. A small injection of saline lifts the esophageal lining away from the muscular wall beneath it, creating a cushion.
3. A small entry cut is made in the esophageal lining, and the endoscope is advanced into the space between the lining and the muscle — the submucosal space. This is what we call the third space.
4. Working through this tunnel, I cut the circular muscle fibres of the LES — relieving the obstruction that prevents food from passing through.
5. The entry point is closed with small endoscopic clips. There is no external wound.
The procedure takes 60 to 90 minutes. Patients are admitted for one to two nights, begin on a liquid diet, graduate to soft foods over about a week, and return to normal eating within two to three weeks.
Why POEM Is Now the Preferred Treatment for Most Achalasia Patients
Clinical data consistently shows POEM achieving symptom relief in 85–95% of patients, with outcomes that hold up well over 5+ years of follow-up. When compared directly to Heller Myotomy in randomised studies, POEM shows equivalent or better success rates — without the abdominal incisions and with shorter recovery times.
POEM is particularly well-suited for:
• Patients with Type III achalasia (spastic achalasia) — where the muscular dysfunction extends higher up the esophagus and a longer myotomy is needed. POEM can be extended to any length; laparoscopic Heller cannot easily.
• Patients in whom previous treatments (balloon dilation, botox) have failed
• Patients who want to avoid abdominal surgery or a longer recovery
• Patients with other esophageal motility disorders — diffuse esophageal spasm, nutcracker esophagus, hypertensive LES — where standard Heller Myotomy doesn't have a role but POEM does
POEM is not suitable for everyone. Patients with significant esophageal scarring from previous radiation, or certain prior interventions that have compromised the submucosal layer, may not be candidates. A thorough pre-procedure evaluation — including manometry and endoscopy — is essential to confirm suitability.
A Clinical Note on Reflux After POEM
One important difference between POEM and Heller Myotomy: when surgeons perform a Heller Myotomy, they typically add an anti-reflux procedure (fundoplication) at the same time to prevent post-operative acid reflux. POEM does not include this component. Studies show that approximately 20–30% of patients develop abnormal acid exposure in the esophagus after POEM — though most are asymptomatic or respond well to a PPI. For patients with pre-existing GERD or significant reflux symptoms, the choice between POEM and Heller Myotomy requires careful consideration. I discuss this with every patient before proceeding.
What This Means for Patients in Secunderabad, Hyderabad, and Andhra Pradesh
When I introduced POEM to this region — becoming among the first ten in South India to perform the procedure — the clinical reality was that patients with achalasia in AP and Telangana had limited local options for advanced endoscopic management. The procedure existed in Chennai, Mumbai, and Delhi. Travelling for a specialised endoscopic procedure is a significant barrier, particularly for patients who are already struggling to eat.
POEM is now available at Medicover Hospitals, Secunderabad. Patients from Hyderabad, Secunderabad, and across Andhra Pradesh — from Vizag, Vijayawada, Guntur, and beyond — can access this procedure without travelling to another city.
If you or someone you know has been dealing with progressive swallowing difficulty, regurgitation of food hours after eating, or chest pain that doesn't respond to reflux medication — please come in for a consultation. A proper manometry study will confirm whether achalasia is the diagnosis, and from there we can discuss the right treatment approach for your specific case.
Book a consultation at Medicover Hospitals, Secunderabad — call +91 9154532511 or WhatsApp the same number.
