Digestive Disease Institute

POEM is the Answer When You Can’t Swallow

Sometimes you experience a health dilemma early in your life, and when you can’t find a solution, you learn to adapt. That was the case for Virgil Leedy, who lives in Weiser, a northern Idaho town with 5,500-plus residents.

Just over 30 years ago, Virgil began to have trouble swallowing. “It felt like I was pushing the food through a wall,” he remembers. He went to a local doctor and his condition was diagnosed as acid reflux. Not surprisingly, nothing prescribed eliminated the problem. Over time, Virgil adapted to the condition by chewing as thoroughly as he could. Sometimes trying to finish the meal became so painful he would have to stop.

image description Now, symptom-free, Virgil enjoys a cup of coffee with his wife, Marla.

Finally, five years ago, a gastroenterologist in Boise determined Virgil had achalasia, an esophageal motility disorder in which a muscle at the lower end of the esophagus does not function properly and obstructs the passage of food and liquid into the stomach. Over time, the improperly functioning muscle, also known as the lower esophageal sphincter, leads to damage of the smooth muscle that makes up the wall of the esophagus. Ultimately, this damage results in a lack of peristalsis — the rippling movement that would normally move food down the gastrointestinal tract.

Individuals with this disorder find it uncomfortable to eat large meals or to eat at a normal pace. They feel like the food is getting stuck and sometimes feel the need to regurgitate. Some people work around the symptoms by sleeping sitting up or eating soft, smooth foods like ice cream. In extreme cases, the esophagus stretches and food becomes trapped inside.

The doctor who diagnosed Virgil as having achalasia told him about a new procedure — Peroral Endoscopic Myotomy (POEM) — that could provide a long-term solution. However, the procedure wasn’t available in Idaho, so Virgil was referred to Virginia Mason and Andrew Ross, MD.

“The esophagus is a very dynamic organ,” explains Dr. Ross, section head, Gastroenterology, and medical director, Therapeutic Endoscopy Center of Excellence at Virginia Mason’s Digestive Disease Institute. “The coordinated movement of the smooth muscle of the esophagus squeezes food and liquid from the back of your throat down toward your stomach. The lower esophageal sphincter relaxes and food drops down to your stomach. It’s all automatic. The only part we control is the swallowing.”

“The disruption caused by the non-relaxing lower esophageal sphincter causes the muscle contractions to become uncoordinated. In some cases, this interruption causes the contractions to stop completely and permanently.”

“For the first time in 30 years I could drink water and have it go right down,” says Virgil.

There are several treatment options for achalasia, including endoscopic balloon dilation, injections of Botox, surgery or the minimally invasive POEM procedure. “Because Mr. Leedy was relatively healthy, we wanted a definitive therapy that would give him the best shot at a longer symptom-free period,” explains Dr. Ross.

The procedure is performed by inserting an endoscope (camera) into the mouth and down the esophagus. The camera is used to create a tunnel beneath the inner lining of the esophagus and makes a pathway that can then be used to access the smooth muscle wall. A special knife is then advanced through the end of the camera and is used to incise the lower esophageal sphincter, causing it to relax.

After this is completed, clips are placed on the lining of the esophagus to close the tunnel. The camera is then removed. The procedure typically relieves the tightness and allows the esophagus to empty more easily and the patient to resume a more normal diet.

Patients usually stay in the hospital overnight and are released the next day. “For the first time in 30 years I could drink water and have it go right down,” says Virgil. The only requirement he has now is an annual visit to Virginia Mason, with his wife, Marla. They can check in with Dr. Ross and some of the other specialists they have been seeing over the years for treatments that are not available in Weiser.

“It’s also a great excuse to check out Seattle restaurants,” Virgil says.

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