Intermountain Health Surgeons Perform New Less-Invasive Procedure to Treat Swallowing Disorder

Surgeons at Intermountain Health are the first in Utah to offer a new less-invasive procedure to help treat patients who are experiencing achalasia, a disorder of the esophagus that makes it difficult to swallow food and beverages.

Traditional treatment options for achalasia have included medication, pneumatic dilation, Botox injections and surgery. Surgery has generally been the most effective treatment for achalasia, which affects about 1 in 10,000 people. The esophagus is the passageway between the mouth and stomach.

During surgery, surgeons cut the muscles of the lower esophagus to help open it up and make it easier for food to pass through. This is traditionally done either through a large incision in the chest called a thoracotomy, or more recently done laparoscopically through the abdomen.

Now, however, there is a new less-invasive option for patients in Utah who have achalasia that doesn’t require major surgery.

Surgeons at Intermountain are now performing a new less-invasive endoscopic procedure called Peroral Endoscopic Myotomy, or POEM for short, which replicates the more invasive surgery without major surgical incisions.

POEM is a relatively new procedure that uses endoscopic technology. A benefit of having an endoscopic procedure for those experiencing swallowing disorders, is that there are no incisions in the chest or abdomen and usually includes a minimal, or sometimes, no hospital stay following the procedure, said David Griffin, MD, a thoracic surgeon at Intermountain Health, who is among the first physicians in Utah to perform the new procedure.

POEM is not considered a surgery, since no incision is made through the skin.

“We’re excited to offer this procedure to our patients,” said Dr. Griffin. “As far as I am aware, we’re the only center performing the POEM procedure between Denver and the West Coast, so it really is a valuable treatment option that will benefit patients throughout the Intermountain West.”

Achalasia and other swallowing disorders are usually caused by the esophagus muscles and the lower esophagus sphincter muscles not relaxing, making it hard to swallow and hard for the food to pass into the stomach. Other symptoms besides swallowing issues may be heartburn, weight loss resulting in an overall lower quality of life.

A benefit of having an endoscopic procedure for those experiencing swallowing disorders, is that there are no incisions in the chest or abdomen and usually includes a minimal, or sometimes, no hospital stay following the procedure, said Dr. Griffin.

“Currently there are only a handful of centers in the United States offering this less-invasive approach to treating swallowing disorders, and Intermountain Health is one of those,” he said.

The POEM procedure originated in Japan and has been performed in the United States for the past two years. Dr. Griffin has already performed the procedure a handful of times, the first use of the procedure in Utah.

Endoscopes are flexible tubes with tiny cameras that can be passed through the mouth. They allow physicians to see and examine the surfaces of the esophagus (food pipe), stomach, intestine, and colon without making a large incision elsewhere on the body.

During the procedure, surgeons use an endoscope tube to tunnel into the lining of the esophagus muscles and make a pathway. Surgeons then cut away and loosen the tight esophagus muscles that are causing the swallowing problems.

Once this is complete, endoscopic clips are inserted at the lining of the esophagus to keep the incision at the top closed. The procedure relieves the tightness and allows the esophagus to empty like it normally should do to allow food to pass unobstructed down into the stomach.

Endoscopic procedures often mean less pain for patients and a faster recovery than open surgical procedures.

POEM is mainly used to treat achalasia, an excessive tightness of the ring of muscle (sphincter) between the esophagus and the stomach.

For people with esophageal achalasia, this muscle doesn’t relax, and other esophagus muscles don’t help move swallowed food down, preventing it from entering the stomach. This can cause coughing or choking, sore throat, food becoming trapped in the esophagus, and even weight loss and nutrient deficiencies, resulting in a lower quality of life.

“This is really an important advancement and a terrific option for patients who are experiencing this disorder,” said Dr. Griffin. “We’re excited to be on the cutting edge of this technology to help restore the quality of life for these patients.”

About Intermountain Health

Headquartered in Utah with locations in seven states and additional operations across the western U.S., www.intermountainhealth.org is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information or updates, see https://intermountainhealthcare.org/news.

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