Incisionless surgery now available as an investigational treatment for esophageal disorder

"This surgical approach not only eliminates the need for external incisions, but also offers greater precision and a faster healing time for patients," said Eric Hungness, MD, gastrointestinal surgeon at Northwestern Memorial.

POEM is performed by inserting an endoscope in the mouth and tunneling it down the esophagus so surgeons can access and cut abnormal muscle fibers that prevent the valve at the base of the esophagus from opening to allow food to enter the stomach. It is currently under investigation and is being offered as part of a clinical trial at Northwestern Memorial.

Sobenes, who was one of the first patients in the country to be treated for achalasia using the investigational procedure, said the choice was easy for him. "What I was going through was terrible. I couldn't eat. I couldn't drink. I wanted to get back to normal as fast as possible and was happy to hear of this alternative," said Sobenes.

More than 3,000 people are diagnosed with esophageal achalasia each year. The most common symptom is difficulty eating solid food and drinking liquids. As it advances, achalasia can cause considerable weight loss and malnutrition. Common treatments for esophageal achalasia include a traditional surgical approach known as a Heller myotomy, or balloon dilation.

"Previously, we had to make at least five incisions in a patients abdomen in order treat esophageal achalasia surgically," said Hungness. "Although the research continues and final results are not known, POEM is an exciting idea that holds great promise for patients and demonstrates the bright future for incisionless surgeries."

Approximately 150 POEM procedures have been performed in the world since 2008. Hungness, together with Nathanial Soper, MD, chair of surgery at Northwestern Memorial, have been among those pioneering Natural Orifice Translumenal Endoscopic Surgery (NOTES). The team was the second in the country to perform a gallbladder removal through the mouth in 2007, and has since removed a gallbladder through the vagina as well.

Doctors stress that treatment options must be carefully selected based on the unique needs of the patient, but say minimally invasive procedures such as POEM have been shown to offer an array of potential benefits including greater surgical precision, a shorter recovery time, shorter hospital stay, less pain and in the case of POEM, a lower incidence of reflux post procedure.

"This is the future of surgery," said Soper. "With each new procedure, we learn how to apply the technique and technology to other surgeries and develop new tools."

Provided by Northwestern Memorial Hospital