Per Oral Endoscopic Myotomy (POEM): A Case-Based Approach to Perioperative Nursing Care

Abstract

Per oral endoscopic myotomy (POEM) is now recognized as a standard therapeutic option for primary achalasia. Since, its introduction in Japan in 2008, the procedure has gained widespread acceptance and has been endorsed by the American Society for Gastrointestinal Endoscopy. In UK, the first successful POEM was carried out a King’s College Hospital in November 2013¹. Per oral Endoscopic Myotomy (POEM) is an advanced minimally invasive endoscopic procedure used in the treatment of esophageal motility disorder, particularly achalasia cardia. This procedure involves endoscopic creation of a submucosal tunnel followed by selective myotomy of the esophageal circular muscle fibers to relieve functional obstruction at the lower esophageal sphincter ². POEM has gained wide acceptance due to its effectiveness, reduced surgical trauma, and shorter recovery period compared to conventional surgical approaches ³. This abstract highlights the clinical aspects of POEM along with the importance of comprehensive nursing care in the pre-procedural and post-procedural phases. A 27-year-old male patient came to gastroenterology department with a compliant of difficulty in swallowing for 4-5 years to both solids and liquids, and has increased in 2-3 years, associated with regurgitation of foods and increased on lying down. He also has a history of weight loss of about 10kgs in 4-5 months. The patient had no history of any comorbidities. On examination, patient was conscious coherent and oriented with stable vital signs. Patient underwent a comprehensive diagnostic evaluation for swallowing difficulty, Barium swallow revealed an esophageal dilated with “Rat Tail” appearance in the GEJ, Upper GI endoscopy, resistance was felt beyond GEJ, with a query of esophageal motility disorder, Esophageal manometry confirmed Type1 Achalasia, Blood report revealed hypokalemia, which he had received IV corrections. Based on the confirmed diagnosis patient underwent an endoscopic surgical procedure Per oral Endoscopic Myotomy (POEM), Which was identified as the most effective intervention to relieve his symptoms.