Achalasia – POEM Method as a surgery alternative

I have achalasia since 2008. In the past I had some 5 balloon dilation. Because this was not really helping me out of my achalasia problems, I searched for another alternative. I spoke to my surgeon on February 2012 and he told me about a new method called POEM (Peroral Endoscopic myotomy).

So I started to investigate in the internet about POEM. I did find some references searching Google using POEM, but more I found using ‘Peroral Endoscopic myotomy’. Like this I found some good articles and even videos. And a lot of people as well as physicians were positively impressed by this new method.

POEM was invented by Prof. H. Inoue (JAP). So far he did POEM procedure in 205 consecutive cases in the hospital at Yokohama. Including the experience in oversea countries it reaches more than 240. Patients who received POEM in his early series are all fine with no sign of recurrence of dysphagia

Two weeks later I decided to apply the new method POEM. I hope POEM will help me in reducing the chest pain, difficulty swallowing and regurgitation during the night.

But how I got to the decision appling to me the surgery method POEM?

Well, as life goes one just get nothing for free. Well, there are a few exceptions, but that’s another topic. I wanted to know where is the catch. Otherwise POEM would be really revolutionary. The only I found negative about the method is that there are no long-term results available. The first operation was done about 3-4 years ago. What happened to this patients and how are they feeling today? I could not find to many information. But it seems that patients which undergone such a treatment had at least for 2 years a much better quality of life. I would estimate that can be extrapolated to another 2 – 4 years, so I think if an intervention using POEM runs perfectly, then you can get about 6-8 years with minor achalasia problems or even cured. These are my personal impressions. Not too bad I thought.

What is the alternative? Balloon dilatation is okay, but it has risks because of perforation, and it can not be repeated to many times. Then there is still the surgical interventions in a traditional fashion. Not controversial and although today these procedures are very well known in the implementation and minimally invasive, it is for the body a much greater trauma (multiple layers must be cut by the operators until they locate the right place of the muscle) as using the method POEM.

Well, POEM seems to me a very sensitive, highly technical supported and gentle way of doing a surgery. After all these positive comments on the internet, knowing that Prof. H. Inoue will personally perform the operation to me, I can not decide otherwise. Also I can contribute more on the long-term experience knowledge.

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127 thoughts on “Achalasia – POEM Method as a surgery alternative

  1. Hello! I am Haru Inoue, MD. Prof. I just see your blog.
    So far we did POEM procedure in 205 consecutive cases in our hospital. Including our experinece in oversea countries it reaches more than 240. Patients who received POEM in our early series are all fine with no sign of recurrence of dysphasia. Theoretically POEM is equvalent procedure to conventional surgical myotomy. Only difference is access route. Haru

    • Dear Prof
      My son aged 20 having the same problem.Do you recommend POEM surgery for him. Is it a permanent cure? How are your patients feeling especially the first patient? Kindly reply.

      • i did the surgury less the two months ago. I can already say that i feel at least a 85% improvment. I can still feel problems at sometimes but not even near the problems i had before. I strongly recomend this surgury to all people suffering with Achalasia.

      • Dear Murali,
        POEM is an excellent alternative to conventional surgery. The main difference is that there is a much less invasive way to cut or divide the affected muscle. In surgery we would have to create multiple incisions either in the abdomen or in the thorax, whereas in POEM everything is just through the mouth. The essence of the operation is the same. You must remember that there is no perfect treatment as the esophagus has a permanent problem with motility, yet a “myotomy” or cutting the muscle is the best form of treatment. It truly improves esophageal function and relieves in most cases difficulty eating (dysphagia). The longer a patient has been untreated, perhaps the less likely that patient will have a complete response. Professor Inoue has the largest single experience, and virtually all of the surgeons throughout the world who do POEM have learned this from him in Japan. We at Stanford have done so far 15 POEMs with very good results.

        You could also see:

        http://www.sfgate.com/health/article/New-surgery-an-option-for-rare-throat-disorder-4349700.php

        http://med.stanford.edu/ism/2013/march/poem-0319.html

        I hope this helps,

        Homero Rivas, MD, MBA, FACS
        @mHealthSurgeon
        Stanford University

      • Hello!
        World first case of POEM was done in approximately 5 yrs ago.
        He is of course fine with no recurrence of the disease. Your son is 20 year old.
        He is best to be treated by POEM.

        Haru.

    • Thank you sir for replying to my query. Now, I have mentally prepared to go ahead with the procedure for my son. I feel there is great hope through ‘God Sent’ person like you in treatment of achalasia cardia. I am happy that your technique is getting popularized throughout the world. I live in India,Chennai.I am looking for ways how to go about for the procedure either with you or with the doctors trained by you.

      • Muralidharan,

        Have you got the POEM done for your Son? can you please let me know what is the cost for POEM in India?

    • Dear Profesor, my name is Sulma my mother in-law, who is 82 years old,suffers from Achalasia for about 5 or 6 years. She lives in Bolivia and she is desperate and willing to undergo the new POEM procedure. What is the risk for her to have this done and is there any hospital in Los Angeles, California, USA to have it done?

    • Dear Doctor
      My wife aged 34 years is also suffering from 6 months with the same disease. Doctor inserted 30mm balloon but was of minimal recovery. Another doctor from Asean Iinstitute of Gastroentrolgists (hyderabad) was consulted and doctor advised to go for POEM for permanent recovery. we consulted again to the doctor who has inserted the balloon, the doctor not advised to go for POEM as AIG is not having the experiance and this procedure is complicated.
      Pls advise whether AIG hyderabad, is having experiance in performing this
      Can we take a chance for performing the surgery in AIG Hyderabad

  2. This is Dr. Minami from Nagasaki. I just performed my 22th POEM last Friday. I am truly amazed by the homepage you have created.

  3. Thank you for the reply. I’m one of Pr. Inoue’s co-workers. I believe you and other achalasia patients will spend your lives without being disturbed by dyphagia symptom. Good luck!

    • IAM INTENDING TO PERFORM POEM IN ZURICH NEXT MONTH ,PLZ LET ME KNOW IF THE OPERATION HAS TO BE REPERFORMED AFTER SOME YEARS OR ITS SOME THING FOR GOOD

      • Hi Nabil,

        It’s supposed that the POEM Operation is done only once, but it depends on each person and of its state of achalasi if the operation has to be redone in future. The method is nearly 4 years old and we all still don’t know how one is feeling after 8 years. In all the ways, if it’s necessary to do it again it is possible.

        Good luck to you and I hope all will be fine.

        Regards

        Roger

      • WILL YOU PLZ GIVE ME AN IDEA ABOUT THE SITUATION LEADS TO POEM OPERATION
        MY CASE IS NOT VERY SEVERE I CAN EAT DRINK ALL KINDS OF FOOD ,SURE I NEED WATER TO HAVE A FINAL PUSH BUT STILL OK. MY WEIGHT IS OK AND I DONT LOOSE ANY WEIGHT.I DID 3 BALOON DILATION AND 3 TOXIN INJECTIONS

      • Hi,

        I am not a doctor, so I can not give you a professional answer, please see your doctor and discuss with him your personal case. As far as you describe your case, yes you can applicate a poem surgery to you and it could help you. If you read about my case on the blog I had the same story and I did it, and know I feel great and I’m very happy that I did it. Prof Seewald from Zurich Hirslanden Klinik surely can answer your questions. You find him by google. Good luck,

        Best regards

        Roger

  4. Hello, I´m a nurse from the university medical center Hamburg Germany we learned to perform the procedure from Prof. Inoue. I´m very curious about your experiences, cause most of the patients we treated didn´t leave a feedback. I hope everything wént well for you. Nils

    • I just received a diagnosis of achalasia and want to explore POEM treatment. I live in Boston area. Can anyone help with a referral or surgeon’ s name or hospital? I would appreciate it so very much.

      • Yes, Dr. Kyle Perry in Columbus, Ohio—just spoke to him this A.M. about my achalasia!! He is great!!

  5. Thank you to the author for establishing this blog.
    Dear Dr. Inoue and colleages, Thank you for all of your work with the POEM procedure. Does POEM have reduced incidence of reflux versus laproscopic myotomy with fundoplication? I have been diagnosed with achalasia with manometry and timed barium swallow. Can you provide the name(s) of experienced POEM surgeons in Chicago and/or the most experienced in the USA?
    Tim

    • Tim,
      I just found this blog. I had POEM surgery on 12/1/11 at Northwestern University Hospital in Chicago. The surgeon was Dr. Hungness. It’s almost one year later and my results have been fantastic. I’ve regained 20 of the 30 pounds that I lost. Though I still have occassional minor symptoms, bread still a little tough to get down, I would highly recommend this procedure. Absolutely no acid reflux either.
      Good luck.
      Peter

      • Hi Peter,
        My son aged 19 having the same problem. He has undergone dilation once. I am eager to know how do you feel after POEM.

  6. Dear Everyone,

    Thank you for creating such an important blog. I have met Professor Inoue four years ago since he was starting this POEM procedure. I have learned to master this procedure from him in Japan, and now we have implemented POEM as the procedure of choice for our patients with Achalasia at Stanford University Hospital. With no doubts, patients with Achalasia do quite well after POEM and recover much faster than with even laparoscopic surgery.

    Homero Rivas, MD, MBA, FACS

    http://med.stanford.edu/profiles/Homero_Rivas/

    @mHealthSurgeon

    • Dr. Rivas:

      I’m glad to hear that POEM is offered in the Bay Area! I’m a 26 year old female and was recently diagnosed with achalasia. I was planning on scheduling the heller myotomy surgery, until I read your post. I’ll be sending you an email shortly to learn more.

      Thanks so much to Dr. Inoue and his team for researching an alternative solution to the laproscopic myotomy.
      Best,
      Meg

    • Dear Homero Rivas. I had a Heller Myotomy with fundoplication done 5 years ago and I am now on a liquid diet as I cannot get anything else down. Has anyone done a POEM on patients that have had a Heller and what sort of results have been achieved? I would appreciate any feedback.

      Thank you.
      Annalisa

  7. I am scheduled for the POEM surgery in January finding this blog has helped me realize that this is the right option for me. Looking forward to being able to eat normal again with family and friends. My surgery will be at UC San Diego with Dr Horgan . I will try and keep updated if that’s something we do do here. :-)

    • Hi Monika,

      I’m glad to know that my blog was able to help you in taking your decision. I wish you all the luck and hope you will feel after the surgery again absolutely normal. About me I can only say that I continue to feel great, no chest pains at all and I can eat everything I wish without problems.
      So again, all best to you and yes, you can also describe your experience here and share it with us.

      Best regards

      Roger

  8. Hello everyone… Well my PEOM surgery has been moved up to December 18 getting nervous now that I have a date but looking forward to getting back to normal. Going in week before for a clean out and than let the process begin. I’ll keep updated … Monika

    • Hello everyone, I found a surgeon who does POEM that my insurance will cover! And had my Surgery done in September 2012. His name is dr David Earle and he practices out if BayStateMedical medical center in Springfield Massachusetts. He learned the POEM under the master dr. Inoue from Japan. I live outside of Boston ,but no one here does this fantastic surgery. That being said , I do think that because the incidence of achalasia is so low, it is best to have a few well-publicized experts specializing in the POEM rather than a lot of doctors doing only a few. Experience does matter. I was happy to travel to western Massachusetts especially since I was considering traveling to Chicago!
      I feel my surgery has given me a new life. I know will always have achalasia. It is not going totally away, but it is soooo much better. I have regained 5 pounds, do not need food supplements or IV fluids, can eat most foods. I rarely regurgitate and can dine with friends and family like a normal person.
      My advice to any one with achalasia is to do the surgery before doing any procedures. Trying Botox or dialations, or Rxs just delays an excellent remedy and takes more out of you…physically and emotionally. I have had many other surgeries, which is one reason I did not want the traditional invasive type. The POEM was less painful and easier to recuperate from than any other surgery I’ve had.
      I also think that one reason it is not touted as much as it should is more political and cultural than medical. It is so obviously a superior method. It may not be for everyone , but it worked for me!

      • POEM is the best available remady for Achalasia my daughter Anna who is 12 year Old just underwent the surgery yesterday and she is getting recovered we started with her light clear water and some two cups of Black Tea before that she went through a Barium sollow and which shows that her Lower Esaofagus Spinster is open and fluid is passing freely, which shows that there is no difficulty to swallow the eatables and drinks, tomorrow we will start with light food and gradually we will shift in to the regular food. Yesterday she had chest pain which is common for this treatment and Doctor has advised the same in advance, we could manage her pain with various medicine and she is happy now anybody would like to have more information and support you can call me or mail me. My Number is +971 50 6170349 currently I am in Japan and anybody need the help pleae contact in this Number or mail me
        Varughese@alzarafa.ae we are in Showa University Northern Yokahama Hospital with Dr.H Inoue the veteran in POEM .

      • Hi,

        Thank you for you testimonial, I’m glad you took your decision and that it worked so well for you too. I absolutely share your opinion that not every physician should know POEM, better a few and they do the job excellent. I also think that when somebody does have POEM diagnostic for sure, POEM should be evaluated as fist procedure. But only a professional can judge for the right method to be used.

        I wish you continue doing every day better, I’m now after 8 month of surgery feeling 100% normal, it’s so amazing. To me it worked great.

        Best regards,

        Roger

    • Hi Ashish,

      Please understand that I can not tell you exactly what a POEM surgery cost in other countries, here in Switzerland the costs are between 17’000.- up to 30’000.- CHF and the health insurance is taking over the costs. In my case I was lucky and had not to pay. But for other countries this can change a lot, so first you have to find the right physician which knows about POEM and has experience. Then you directly talk to him about the costs.

      I wish you good look and hope you will be soon fine.

      Bests regards,

      Roger

  9. I had a heller myotomy in 2000. After 12 years of success, I now need a dilation. I have been told that because I had the Heller I can not have POEM in the future, if I need it. Does anyone know if this is true and can you explain why? Thank you. Elyse

  10. Pete,
    Thank you for your Reply. I had the POEM procedure with Dr. Soper and Dr. Hungness on December 4, 2012 at Northwestern Hospital. Everything went very well. I look forward to a similar one year outcome. My personal email is tocasek@gmail.com. Do you mind sending me an email so I can discuss Soper and Hungness follow up experience with you?
    Monika,
    Don’t be too nervous. I have never had surgery before this. It lasted about two hours. The pain or discomfort afterward is not bad and is easily controlled. You are up and walking and comfortable the next day. I am on liquids for the first week and swallowing is totally normal. I will be on soft foods next week and I expect that to be fine also.
    Roger,
    Thank you for this blog. I was more comfortable with my decision after reading about your experience. You are very generous to provide this.
    Elyse,
    One of my surgeons, Dr.Soper, used to do the Heller myotomy and still does, even though he also does the POEM procedure. If you would like to call him regarding POEM after Heller myotomy his phone number is 1-312-695-8918. Also, article number three below by Dr. Inoue on page two refers to POEM after surgical myotomy (meaning Heller lap myotomy, I believe). It says: “Recently the indication for POEM was extended to failed surgical myotomy cases or failed previous POEM procedures, according to authors’ unpublished data from Digestive Disease Center of Showa University, Northern Yokohama Hospital, Japan. Currently, the authors make no exceptions when considering the application of POEM.”

    All,
    I would like to post a summary of my experience as my recovery progresses. So far, I am very pleased. I am listing some of the medical articles that I found on scholar.google.com that helped me make the choice to have the POEM procedure:
    1) July 2012 article by Drs. Soper, Hungness, et al about their first 18 POEM cases.

    http://link.springer.com/article/10.1007%2Fs11605-012-2030-3?LI=true#page-1

    2) February 2010 article by Dr. Inoue about his first 17 POEM patients.

    http://www.laparoskopi.nu/_uploads/files/poem.pdf

    3) July 2012 article by Dr. Inoue, et al based on 200+ cases and summarizing results on P.8.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414088/

    4) November 2011 abstract of article by Dr. Inoue, et al regarding 16 patients.

    http://link.springer.com/article/10.1007%2Fs11605-012-1868-8?LI=true#page-1

    5) 2012 article by Dr. Ponsky, et al regarding how he performs POEM.

    http://www.nature.com/ajg/journal/v107/n3/abs/ajg2011388a.html.

    Best Regards to all,
    Tim

  11. Hi there , my mother has the symptoms of oesophageal achalasia , she has lost heaps of weight aged 68 . After a friend forwarded some info on this disorder we started to investigate some possibilities of help . We saw a you tube video on the new procedure Peroral Endoscopic Myotomy , this procedure seems like it would benefit us ,we are in Tasmania and are at the end of the earth , does anyone know if there are any surgeons doing this procedure in Australia ?

    Regards Paul

  12. I am a male aged 54 living in England and prepared to travel anywhere for treatment and definitely favouring. POEM
    I have tried to contact Prof innoue without success and would also like to know if thereareanyexperts in Europe – I understand Germany is the country where most treatments have been carried outin Europe
    Can any one help me

    Vincent
    vford@deford.co.uk

    Mobile uk 07889 706680

      • Dear Mr. Igbluz,

        I read your comment right now.
        One of the best way is to visit Prof. Stefan Seebald in Hirslanden Clinic in Zurich.
        I visit periodically to Hirslanden and perform POEM together with Prof. Seebald.
        Mr. Roger also received successful POEM which appears in his blog.

        Haruhiro Inoue, MD. Prof.
        Digestive Disease Center, Showa University Northern Yokohama Hospital

  13. Vincent,

    there is Prof. Hubert Piessevaux in Clinique Saint-Luc in Brussels who does POEM, I’m scheduled to have it performed by him soon. I’ll let you know how it went.
    English is not an issue here, just don’t know whether you could have a scheduled operation paid by your British insurance.

    Dominik

    • I can really recommend Prof. Hubert Piessevaux. Now it’s over 1 month after the POEM and I’m eating almost as if I never had achalasia. And it was bad – I lost 20 kg in the last 2 months before the operation.

      I went out from the hospital 24 hrs after the procedure and I needed only 5 days of sick-leave from work. Although I had to take strong doses of paracetamol for 2 weeks before the pain went away, I could drink and eat pulps in less than 1 day after. That’s amazing.
      And Prof. Piessevaux really cares about his patients.

      If anyone is willing to come to Belgium to have POEM performed, I could provide his contact details.

    • Hi,

      Habe a look to my blog, around 21 of march, there I have written my experience. I think 2 days after the surgery you can start to eat fluid food, like joghurt, soups and so on, after one week you can start to eat purée, fish and like this, after one month you can eat all you like.
      I wish you good look and you will see how fine you will be feeling afterwards.

      Best regards

      Roger

      • Thanks! I’m looking forward to it!

        I’ll check in with an update after the surgery =)

  14. hi i would like to know is there any doctor in malaysia can do the POEM?last 8month i did the Heller myotomy surgery but my achalasia dont go away.until now evrytime i eat solid food i will vomit.where is the best place to do poem?im willing to travel.i lost 20kg for the last 8months.pls help me:(

    • Hi Afique,

      I do not know if there is any doctor in Malaysia able to do POEM. But I know that in Japan Prof. Dr. H. Inoue, which cured me from Achalasia, is the best possible surgery for doing POEM. You will find his eMail on the Internet and also on this blog you find a link about his website with all the explanations about POEM.
      I wish you good luck.

      Best regards,

      Roger

      • For the treatment of persistent disphasia after surgery, POEM is the best. But technically it is not so easy. If you are possible to come to Japan, I can treat you. Among our 330 cases we treated more than 10 cases of surgically failed patients.

        My address is
        haruinoue777@gmail.com

      • thanks for the info roger..

        Prof. Dr. H. Inoue i sent u an email.i hope u will reply soon.tq

  15. Hello all,

    i’ve had poem almost three months ago but now i’ve still problem about food’s swallow. I underwent the procedure by prof. Costamagna in Rome. Now I’m really unhappy because I don’t what I can do and if there’s a solution. One months ago the surger check me up and he sais it was all ok but my symptoms didn’t say the same thing. Surely I’ve to recall but there’s someone who after poem have my same problem???
    Thank you all…. Francesca

  16. Hello everyone,
    I would like to thank all of the peeple here for sharing valuable information. I am Greek, male 35 years old and I have been diagnosed with stage I achalasia three months ago in Athens Greece (I think I have moved to stage II now judging from the much worse symptoms I have). I have chosen not to receive any treatment yet.

    I have spent a lot of time reading and visiting doctors and I have concluded my concernes in the following list. I post it for two reasons, one in order to hear opinions and answers and two to help more people who are lost in the information!

    Personally I am examining to go to Japan and have POEM performed by dr Inoue. I have just sent an e-mail trying to get information regarding planning and cost. So if anybody can help on that too I would be greatful.

    Here are the concerns:
    • How does it prevent reflux?
    • If the patient develops reflux in the future what options does he have? Can he have a fundoplication? If yes, is the fundoplication performed on a patient who has undertaken POEM different than the fundoplication performed combined with the Laparoscopic Heller Myotomy?
    • If the patient develops dysphagia symptoms in the future what options does he have?
    • Is a person who has undertaken POEM a good candidate for a second POEM? What are the difficulties?
    • Is a person who has undertaken POEM a good candidate for a Laparoscopic Heller Myotomy with fundoplication? What are the difficulties?
    • Strategy question: If I undertake a pneumatic dilation now in order to gain some time until further results and clinical tests are done regarding POEM, how would this affect my future options?
    • Generally, what are the disadvantages of POEM and what its advantages.

  17. Dear Professor,
    I am very excited to hear about this revolutionary new technic called POEM. And even more excited that this was performed recently at AIG in Hyderabad from were we are located.

    My Wife aged 30 yrs has had two Ballon dilatations done (six month apart) and then followed by Heller Myotomy with fundoplication exactly 5 years ago. She is feeling fine now, though it takes more time to have her regular food. Recently she started experiencing the same kind of problem what she faced 6 years back. This is more in particular when she takes cold beverages and bread.

    I would like to know if it is advisable to opt for POEM even after having two dilatations and Heller Myotomy fundoplication.

  18. Dear YVK,
    Thank you for your concern to POEM procedure.
    Yes! POEM is effective even after surgery.
    So far we performed POEM procedure to 12 surgically failed cases.
    In all cases symptom score (Eckerdt score) is dramatically improved.
    In your wife case we can perfrom POEM. But before it please try a balloon dilation once again. We hope it may be effective. If balloon dilatation is not effective, we can perform POEM procedure.
    Haru.

    • Dear Professor,
      Thank you for your valuable advise. Would there be any risk of perforation if dilatation is done now? I was told by one of the surgeon that the inner muscle is already weak after the two dilatations and as the outer muscle is now opened during the surgery, there may be a risk of perforation. Please guide me in taking a decision.
      Thanks once again.
      YVK

      • Recuurent symptom of dysphagia after surgery sometimes reacts very well to balloon dilatation.
        It is upto each case condition, but generally 20-30mm balloon dilatation is enough to control symptom. That is the reason why I recommend you to try balloon once before poem.
        But balloon dilatation always has potential risk of perforation (5%) any time.
        If you feel uncomfortable, direct receipt of POEM will be good strategy.

    • Dear Doctor
      My wife aged 34 years is also suffering from 6 months with the same disease. Doctor inserted 30mm balloon but was of minimal recovery. Another doctor from Asean Iinstitute of Gastroentrolgists (hyderabad) was consulted and doctor advised to go for POEM for permanent recovery. we consulted again to the doctor who has inserted the balloon, the doctor not advised to go for POEM as AIG is not having the experiance and this procedure is complicated. pls advise

      • Hi,
        I’m not a doctor but I had achalasia and Prof. Inoue used the POEM Procedere on me. Now I’m 100% fine and I think POEM can help to the most cases. But yes, it is high technology medicine and the doctor has to have experience. So go and search a doctor with good experience in using POEM.

        Good luck,

        Regards,

        Roger

  19. I’m a 64 year old male who has been diagnosed with achalasia which developed over the last five months. I am also considering the POEM surgery. I live in Los Angeles. Would Dr. Inoue please refer me to a surgeon, in my area, who has had the training (preferably by you), to perform the procedure. Thank you.

    • Dear Larry,
      Not sure of who could see you in Los Angeles, but you can come to Northern California. We have been doing POEM very successfully for the last year. I learned this technique from visiting Dr. Inoue in Japan two years ago.

      You could also see:

      http://www.sfgate.com/health/article/New-surgery-an-option-for-rare-throat-disorder-4349700.php

      http://med.stanford.edu/ism/2013/march/poem-0319.html

      I hope this helps.

      Feel free to contact me if you have any questions.
      Warmest regards,

      Homero Rivas, MD, MBA, FACS
      hrivas@stanford.edu
      @mHealthSurgeon Twitter
      Stanford University

    • Dr. Santiago Horgan at UC San Diego does the POEM surgery. He did my HM /wrap in Dec. 2012 . I didn’t do the POEM because it is still in clinical trials too many unknowns for me plus it was unsure if my insurance would pay for everything involved with a clinical trial. And I just couldn’t take that chance. I will add that I am doing GREAT !!!

    • Dear Larry, hello! Now you are living in Los Angeles. I recommend following doctors; Dr. Homero Rivas in Stanford, Dr. Lee Swanstrom in Portland and Dr. Santiago Hogan in UCSD. Haru.

    • Dr. Stephen DeMeester at Keck USC hospital in Los Angeles does the poem procedure. He started this past October.

      • Hello Synthia, did you have POEM done by Dr. DeMeester? I live in Southern California and I’m interested in having this procedure. Also would like any information regarding costs, insurance coverage on this new procedure.
        Thanks! Best Achalasia blog by the way!
        Annabelle Pla

      • I am scheduled for a poem with Dr. DeMeester June 18. Some insurances cover and others don’t. I will let you know more details as I find out.

  20. I just finished a manometry. waiting on results. I am adverse to surgery after having brain surgery 5 years ago however I don’t want to wait so long I ruin my esophagus.Is there a doctor in the Ohio or surrounding region that you would recommend for the POEM? And is the only reason to go for the Heller instead of POEM because of lack of evidence of the outcomes of the patients so far? (medically speaking) I realize many insurances might not want to pay for this as it is still considered a clinical trial) Although I would think it is cheaper being there is less cutting and less hospital stay.

    • Try Dr. Jeff Ponsky and Dr. Jeff Marks both at Case Western University Hospitals in Cleveland. They have had very successful series of patients with POEM in Ohio.

      • Hi Polly,

        As owner of this blog I would be very glad if you could tell your story/testimonials on my new forum achalasia.freeforums.org Also your experience with surgery and physicians, all this will help to all others with achalasia.

        Best regards and I wish you good luck,

        Roger

  21. Dear Polly,
    I also think Dr. Jeff Ponsky and Dr. Jeff Marks are excellent “POEM” doctors in Ohio.
    Haru.

  22. Thank you Dr. Inoue. Can you tell me what the drawbacks to this surgery are compared to the Heller? Or can you point me to any materials I can read about this? Thank you for the time you spend with us answering questions I know you are a very busy man!

  23. Dear Polly,

    Please access to “achalasia-poem.net”
    Almost all information appears on it.
    You can access not only patient information but also description to doctors.
    Haru Inoue, MD.

  24. This site has a lot of great information. I was referred for the POEM procedure. I had a lap band for seven years and now have a gastric sleeve — can you have the POEM with the gastric sleeve? I would guess that a wrap would not work because of the smaller stomach that I have.

    Rachel

    • Hi Rachel,

      I’m glad you like my Blog. I will also copy your question to my new forum achalasia.freeforums.org, a forum is more appropriate for interconnecting people and exchange knowledge.

      Best regards,

      Roger

  25. Dear Mr. Prof. Inoue
    I am 31 years old living in Turkey and I am achalasia since 2 or 2.5 years. I had 2 ballon dilation first in october 2012, 30mm the second in january 2013, 35mm. still I am very bad and I lost 20pounds after the second dilation. I would like to contact you and come to your hospital as soon as possible for POEM. If it is possible can you give me appointment.

    thank you

  26. Hi everyone.
    My husband has been suffering from achalasia for about 6 years. He has tried to manage it by taking pills like calcium channel blockers etc before each meal but even increasing the dose substantially doesn’t really help anymore. And of course the medicine has side effects.
    We’ve became happy reading about the POEM procedure. It seems that Dr. Inoue has made a great contribution to medicine and we’re all thankful to him.
    We would like to inquire if POEM could be performed successfully in my husband’s situation and try it if possible.
    We’re curious about the cost though. POEM is not performed in my country and we would prefer to go to the U.S. to have it performed by an experienced doctor there.
    I know the total cost would change from one patient to another but can anyone at least give me an idea regarding the cost of the operation alone in the U.S.? I don’t even know if it would be close to USD 10.000 or USD 100.000. And I don’t know what anyone can do in this type of a situation if it is far from being affordable.
    Thank you for creating this useful blog and thank you in advance for your comments.
    Sanem

  27. For those interested in POEM, I have posted a list of the doctors and hosptals that are doing POEM on theFacebook Achalasia web site. https://www.facebook.com/#!/groups/77953468660/ That group is open to all, but you must be “approved” for membership (All get approved) The direct link to the file is at

    https://www.facebook.com/groups/77953468660/10151362811013661/

    or https://www.facebook.com/download/188049864679777/POEM%20Doctors.docx

  28. Hi Sanem- I had my POEM done by Dr Ponsky and Marks in Cleveland, Oh. My total cost was around $35,000 USD. Luckily, I have insurance that covered most of it.

  29. again. I can sleep at night, and I’m not shackled to such a rigid schedule of eating/not eating and knowing it was coming back up anyway. Once in awhile I have to drink extra water to get lettuce or vegetables down, but it’s very infrequent.

    I do take Prilosec 20mg once a day, but I had acid reflux before the surgery so it’s not a surprise. I actually have less problems with heartburn now, I used to get it so badly that nothing would get rid of it. As long as I don’t eat too close to bedtime (I try to wait an hour), I have no issues. If I do end up with heartburn, it’s usually because I don’t eat and get super hungry or eat too much.

    At my last barium swallow at the end of December, my esophagus was almost completely back to normal. I had a great GI doctor who nailed the diagnosis right away, did the required testing and referred me to the surgeons ready to go. I’m so glad I didn’t have to go through the more invasive surgery, I hope this procedure will be the first option, I was out of the hospital the next day and the recovery was fast because I didn’t have any ouside stitches.

    I can’t say enough great things about Dr. Ponsky and Dr. Marks. They gave me my life back.

    • I don’t think my entire post posted:

      I had the procedure at University Hospital Cleveland by Doctors Ponsky and Marks on August 30th, 2012. Talk about immediate relief! I was throwing up every single night, and it didn’t matter if I hadn’t eaten for 6-8 hours before. I would wake up an hour after laying down coughing and throwing up. Sometimes I would throw up so violently, I would have to pinch my nose closed so it wouldn’t come out that way. I wasn’t sleeping, I aspirated and got pneumonia because of it, it was miserable. It didn’t matter what I ate or when I ate, it was all coming back up (and mostly undigested) that night. I went through boxes of tissues next to my bed, spitting up throughout the night. Once I would throw up, I could finally get an hour or two of sleep. I had a constant hacking cough. This went on, getting worse and worse, for almost a year before I went to my GI doctor to figure out what the problem was.

      I can sleep at night, and I’m not shackled to such a rigid schedule of eating/not eating and knowing it was coming back up anyway. Once in awhile I have to drink extra water to get lettuce or vegetables down, but it’s very infrequent.

      I do take Prilosec 20mg once a day, but I had acid reflux before the surgery so it’s not a surprise. I actually have less problems with heartburn now, I used to get it so badly that nothing would get rid of it. As long as I don’t eat too close to bedtime (I try to wait an hour), I have no issues. If I do end up with heartburn, it’s usually because I don’t eat and get super hungry or eat too much.

      At my last barium swallow at the end of December, my esophagus was almost completely back to normal. I had a great GI doctor who nailed the diagnosis right away, did the required testing and referred me to the surgeons ready to go. I’m so glad I didn’t have to go through the more invasive surgery, I hope this procedure will be the first option, I was out of the hospital the next day and the recovery was fast because I didn’t have any ouside stitches.

      I can’t say enough great things about Dr. Ponsky and Dr. Marks. They gave me my life back.

      • Hi Shayna,

        Thank you for sharing your testimonial about your POEM experience at my new site achalasia.freeforums.org. I read it and it sounds great and I’m very happy for you that all went well.

        Best regards,

        Roger

    • Hi Shayna,

      I love your feedback and I’m so glad that the procedure went well and you already feel better. The weeks following in my case I also felt sometimes still the hearth burn but after 2 month it went away and now I do not feel anymore. So be confident that soon you will feel much better.

      Just yesterday I meet Prof Inoue in Zurich at I thank him for his work and and from all of us we are so thankful that I travels around and let share his knowledge to others.

      Best regards,

      Roger

  30. I had the POEM procedure done last week 6/2013 by Dr Draganov at Shands Hospital in Gainsville, FL. Everything went great and it appears to have alleviated my systems for Achalasia!

  31. I had the poem procedure June 18 at keck USC medical center in Los Angeles. Dr. Stephen DeMeester was the surgeon. It has been three weeks. I am eating a soft diet, but feel much better and was told I could start eating more foods next week. My heart burn is at a minimum and much better than before the surgery. I am also sleeping better. I never had surgery before but felt this was an easy surgery.

    • Hi Synthia,

      I’m in the progress of scheduling the same procedure at USC. Were you getting heartburn before the procedure? Do you have problems with acid if you ever sleep without being elevated? I’m looking forward to the relief from the surgery but am concerned primarily about acid reflux.

  32. Hi
    I have 50 years old, and achalasya since 2 years. I made two dilatations without great results, some little improvements in the first months and then got worst. In the last month an awfull condition occurred, my esophagus blocked totally due to a huge phytobezoar . I ran internet looking for solutions to achalasia. I read a lot about POEM, and I thought that this is an auspicious treatment, even without great follow-up times. Unfortunately I live in Portugal. Would Dr. Inoue please refer me to a doctor, in Portugal or Spain, (trained preferably by you), to perform the procedure ?
    When I was looking in internet for hospitals or clinics and POEM, I found a private clinic in Zurich – Prof Seebald. I do not know if my insurance cover any part of the costs, but I’d like to get an idea of the costs of this procedure in a private basis. Anybody can help me?
    Thank you for creating this useful blog

    • Hi Ana,

      I had been in Zurich with Prof Seewald. He is working together with Prof Inoue and from time to time Prof Inoue comes to Zurich for doing the procedure himself. I had that luck! So about the cost, for me the insurance covered everything and including the 8 days of hospital the cost was around 25’000 CHF. I hope you can find a good solution for you and wish you all the best,

      Best regards,

      Roger

      • Thank you Roger. Your information was very useful. This blog gives hope to people suffering from achalasia like me. All the best to you

  33. Hello everyone,
    I would like to thank all of the people here for sharing valuable information. I have been suffering from Achalasia for about 10 years. Does anybody know if there is a doctor in Canada who can perform POEM procedure?

    Thank you all….Cathy

  34. Hello everyone ,
    My mother has been diagnosed with Achalasia in January 2013 . We live in Tasmania and don’t seem to have Doctors here who have the appropriate medical equipment to diagnose this Achalasia ,after much google searching we finally found a doctor in Melbourne who was able to give some diagnosis on why the eating disorder and chest pain was occurring . We have learnt much from all these blogs and also have learnt about the POEM method of surgery. I believe that Australia has no surgeons who are trained in this method yet .
    We have the balloon dilation and the Botox procedure done and both have worn off , while the Botox lasted for about 3 months we really need the POEM method of surgery soon as I see her in a desperate way and her body wasting away before my eyes . I believe there are approximately 5 or so people in Melbourne who are seeking this surgery currently .
    We are desperately seeking a surgeon who would come to Melbourne Australia who can train the surgeon in Melbourne to be able to preform this POEM method of surgery .
    Is there any surgeon that can help .

    Regards Paul

    • Hi Paul,

      I will sent your request to Prof. Dr. Inoue, maybe he can help you in one or another way.

      I wish your mother good luck and be confident to find a suitable solution for her case.

      Best regards,

      Roger

    • Hi Paul
      I am currently training two Australian physicians in POEM at Johns Hopkins Hospital. I am hoping that they will start offering this procedure in Australia in Summer of 2014
      Best
      Mouen Khashab

  35. Hey Roger

    Great blog you are managing here, it is interesting to read that other people have similar problems. I have alredy had 2 dillatations and am now at the point where I have to go to surgery, because it’s closed again…

    You don’t know by any chance, when Dr. Inoue will be in Zurich the next time? It seems you are stil in contact with him.

    Cheerio,
    Raphi

    • Hi Raphi,

      I don’t know when he will be in Zurich, but you can also ask Prof. Dr. Seewald at the Hirslanden Hospital in Zurich when he will be. By the way Mr. Seewald assisted Prof. Dr. Inoue when I was undergoing the procedure. He is very well prepared.

      I wish you good luck.

      Best regards,

      Roger

      • Hi Roger

        Thanks for your reply. I had an appointment with Dr.Seewald and I’m going to have a scope for further clarification and then POEM on October 30. Dr. Seewald really took a lot of time to explain the whole procedure to me, I’m 100% sure I’ll be in good hands and it will be all fine.

        Cherrio,
        Raphi

      • Hi Raphi,

        I’m very glad that you got a good impression about Dr. Seewald and I’m sure you will be very happy once all is over. I wish you all the best .
        Yours Roger

  36. Hi all
    I have been performing POEM at Johns Hopkins Hospital for the last 1.5 years and we have had great results. Please see the follwoing 2 links and hope they will be helpful. One is an interview with a patient who had POEM at Hopkins and the the second is Q/A type video that also includes an animated illustration of the POEM procedure

  37. Thanks for Mr. Roger who is all time following all patients problems in all times , my question who is Mr . Roger ? is he working with Prof. Dr. Seewald , or ………….?
    Pls , clarify .

    Thanks for corporation .

    • Hi Jim,

      If you read my blog, you should find out that I had achalasia, and Prof. Dr. Inoue together with Prof. Dr. Seewald did the Poem procedure on me and the blog aims to tell the long term results of poem on myself, nothing more.

      Best regard,

      Roger

  38. I underwent​ ​the​ ​POEM​ ​procedure, performed by Dr. Inoue,​ ​exactly three months ago and I want to provide a quick overview​ ​of​ ​my​ ​case and the remarkable outcome.

    Background

    I’m a 46 year old male who had suffered from achalasia for over six years. My case was particularly challenging because of anatomical changes to my esophagus, which had become acutely enlarged and sigmoidal.

    Dysphagia for both solids and liquids​ ​were​ ​acute, and only barely manageable medically with high doses of nitrates​ ​and calcium channel blockers. I had acute postprandial regurgitation of solids and fluids as well as nighttime regurgitation, which largely prevented sound sleep.

    My quality of life was exceptionally poor and it was deteriorating. The symptoms were sufficiently acute that I was unable to work and struggled to even maintain my weight and get through the day.

    The Procedure

    Dr. Inoue​ ​performed the procedure, which lasted only 61 minutes, on Monday ​afternoon and by noon on Tuesday, less than 24 hours postoperatively, I was not only released from the hospital but I was taking a several kilometer walk with my wife.

    I experienced almost no discomfort postoperatively, even when in the recovery room, with just mild NCCP (ranking at most a 1 to 2 on a pain scale of 0 to 10) and I did not take any pain medication sans an initial dose provided prophylactically while in the recovery room.

    In fact, the greatest discomfort was the insertion of the IV and a-line. In other words, the discomfort associated with POEM was so minimal that it was barely distinguishable from a standard endoscopy.

    The Outcome

    Within four days of my procedure, I was consuming a normal ​diet with virtually no dysphagia​ ​for solids (currently >95% symptom relief) and absolutely no​ ​dysphagia​ ​for liquids. Regurgitation was completely resolved and I have not experienced any symptoms of GERD whatsoever.

    In short, the procedure effectively​ly​ gave me my life back and I’m eternally grateful to Dr. Inoue for developing this procedure and for his remarkable skills in performing the procedure.

    I can say with absolute moral conviction that, if you suffer from achalasia, POEM can literally transform your life and that, if at all possible, you should have Dr. Inoue perform the procedure.

    Steve…

    • Hi Steve,

      Thank you so much for sharing your experience with us! I’m so glad that for you everything went without problems and that after such a short time you were able to leave the hospital and to start doing your normal life. To all what you tell I agree absolutely. Prof. Dr. Inoue is the greatest!

      I wish you all the best and I’m glad to get from time to time your reports how are you going on.

      Best regards,

      Roger

  39. Hi Please give me some advice. I contacted Prof. Inoue via his gmail address and orginally he answered me and then I have heard no more. I realise he is a very busy man and so I was wondering how did you proceed to have a procedure done by him? What are the steps I must take to see him and obtain his opinion? Thank you. Annalisa

    • I contacted Dr. Inoue via email on May 28th summarizing my medical history and I asked if the POEM procedure was a proper treatment option in his opinion.

      WIth his affirmative reply and information about costs (as medical insurance did not cover the procedure out-of-country), I requested via email to be scheduled.

      By May 29th, just one day later, I was scheduled and the procedure was performed on June 10th.

      • Thank you for your reply. I shall have to assume therefore that Prof Inoue must think, for some reason, that the procedure won’t work in my case. I am glad to hear that it has given such good results to those on your site. Regards Annalisa.

      • Annalisa, I would suggest that you email Dr. Inoue once more, asking very specifically if you’re a candidate for POEM and, if so, asking to be scheduled for the procedure. In the alternative, you could call his office.

        POEM is life changing, or at least it was in my case. Do not give up. Determine if you’re a candidate for the procedure. Don’t let one or two missed emails dissuade you.

        Steve…

      • Steve would you have Prof. Inoue’s postal address or know which is the best website to find it?

        Thanks,
        Annalisa

  40. My problems are the same as some. Heller myotomy, fundoplycation. Back to square one. My dr. Said I need poem. I live near Los Angeles, can it be done by a dr there ??? I am 59 years old and my digestive problem started at birth. By age nine I had bleeding ulcers. It my be important to tell to I have severe anxiety that is not well controlled by meds. I have a pace maker. I have broken my back about four times. I took nexium so long I now have osteopenia. I now tale Zantac daily, hyoscyamine every four hrs and Dexilant every morn. I have lost sight of a future w/o health problems. Will POEM help me. My dr said it is what I need.

  41. Salve,
    Ecco la mia opinione sul mio intervento per trattare i sintomi della acalasia.
    Condizione della malattia
    Sono un giovanotto sui 35+ anni, da più di 10 anni che ho l’acalasia. Tutto cominciato con dei dolori nel petto e poi i classici sintomi: disfagia per solidi e a volte per liquidi, scialorrea, rigurgito del cibo di notte, oltre che uno sforzo enorme per mangiare.
    I sintomi tendono a peggiorare con il tempo e in questi anni mi si è formato un megaesofago (deformazione sigmoide tipica della acalasia avanzata).
    Mi sono deciso a fare l’intervento piu “nuovo” la POEM (Per oral endscopic miotomy)… si entra dal esofago, si fa un tunnel tra le pareti del esofago finche si arriva al maledetto (nel mio caso) cardias che si trova bello chiuso… Per poi tagliare le fibre muscolari finche si rilassa e perde forza.
    Ho fatto l’intervento con la equipe del professore COSTAMAGNA.
    Sono stati bravissimi, complimenti a tutto lo staff, specialmente al dottore FAMILIARE e GIGANTE. Che hanno trovato il problema e deciso che secondo le prove, l’intervento era da fare al più presto possibile.
    Vi racconto come andata…
    L’intervento
    Il primo giorno al ospedale, era il mio primo giorno in assoluto, non mi ero mai fatto NULLA, nessun intervento.
    Era naturale che avessi un po’ di paura. Ho visto tanti video del’intervento dunque sapevo cosa si doveva fare ed anche i possibili pericoli e le difficoltà, il prof. COSTAMAGNA mi aveva già indicato che sarebbe stato un intervento difficile.
    Dopo analisi varie, il giorno dell’intervento è arrivato. Sono MOLTO contento che l’intervento è stato eseguito di LUNEDI ed il primo del giorno, circa le 830 del mattino…
    La mia anestesia generale. I medici sempre MOLTO attenti e disponibili.
    1. Anestesia e risucchio di liquidi nello stomaco. Procedura simile alla manometria, tubo che entra dal naso per pulire l’esofago. Anestesia con gas, una meraviglia, da un secondo all’altro sei in un profondo sonno, mi ricordo che ho sognato tante cose.
    2. Dopo 2.5 ore più o meno, mi risvegliano, mi ricordo ancora che stavo sognando. Le prime sensazioni: Irritazione alla gola, e qualche sensazione interna al livello del cuore. Tutto normale.
    Al giorno dopo, primo test per verificare che non ci siano perforazioni nel esofago, importantissimo. Il “tunnel” fatto viene sigillato con dei clips che dopo vengono defecati. Si è verificato con successo che non ci siano perforazioni, si è anche visto che il liquido passava verso lo stomaco. Questo era già un successo parziale. Poi si dovrebbe confermare l’esito del’intervento quando si mangiano cibi solidi.
    Il Risultato
    Dopo l’intervento non ho avuto dolori ma alcune sensazioni al petto. Non ho fatto sforzi ed mi sono trattenuto la tosse. Tutto bene direi. Dopo 3 settimane, i cibi solidi e liquidi entrano bene, senza problemi, si sente che la valvola del cardias e piu rilassata. Dunque posso considerare l’intervento un successo. La peristalsi del mio esofago non tornerà mai più, ma con un piccolo aiutino posso mangiare di tutto (faccio una bolla d’aria per far passare il cibo, cosa che prima era molto difficile ed era uno sforzo tremendo).
    Follow up
    Tra qualche mese una gastroscopia per controllare lo stato del esofago!
    Ringrazio di cuore al professore, alla sua attentissima equipe è al ospedale Gemelli di fornire la possibilità di questo moderno intervento!

  42. Hello everyone ! I’d like to share my testimonial about the POEM procedure that was performed on our 11 year old daughter, by Prof Inoue and his team at Yokohama, in March 2014.
    We are from Mumbai (India), and our daughter was diagnosed with Achalasia in December 2013. It was a very anxious time for us, and after using all sources of information such as doctors, books and of course the internet (including Roger’s blog ), my husband and I were convinced that POEM would be our choice of treatment for our daughter.
    We corresponded with Dr.Inoue, the expert and veteran in POEM with her reports etc, and the procedure was scheduled for 5th March 2014 in Japan.
    Dr. Inoue performed the procedure on our daughter, and the entire team at the hospital was wonderful. They took excellent care of our daughter, and though we ever overseas travellers, we did not have any problems at all during our stay.
    The relief was immediate. Its now two months since then, and our daughter is doing fine. She enjoys eating and her weight has also improved.
    While researching on different types of treatment available for the treatment of Achalasia, in December, we had come across Roger’s blog. Reading through it and the experiences shared by others on this blog helped us in making a choice for our daughter, and also the courage to proceed with the same. We hope that in turn, our testimonial can help others suffering from achalasia. We can be contacted at vmumbaicontact@gmail.com

    • Hi Vinita, I’m very happy for you that you had such a good experience and that your daughter feels now much better. Thank you for reporting your testimonial here and like this to give hope and confidence to all others. I wish your daughter all the best for her future and I’m sure she will be fine.
      Best regards, Roger

  43. Hi everyone, could you please tell me from your experience communicating with Dr.Inoue what is the average time it takes him to answer emails?

    I have written him over a month ago, and then sent him a reminder over a week ago but still have no reply, ( he asked me to send my test results to him, therefore I have the right email address )

    I am a 61 years old engineer, an Iranian, living in Africa, I was also diagnosed with achalasia few months ago even though I don’t have the common symptoms such as loss of weight, vomiting or coughing, that is why I am trying to get a second opinion from Dr. Inoue before arranging a poem surgery.

    Faramarz

  44. Hi Roger,
    I just returned home after a successful POEM surgery yesterday. thank you for your advaice which helped me a lot to make up my mind & fly to Zurich. I was too very luckey that the surgery was performed by Prof.Inoue & Prof.Seewald. Both the doctors were very kind & nice people. I just stayed only for two nights at the hospital & I was out. started on solid food on the Sixth day onwards & belive me it felt really good after suffering for two years. So now I have sarted to live my normal life without any side effects so far. thanks to you & everyone who contributed in this forum helping people change their lives. if there is anyone who would need more information, i would be glad to help.
    Good Luck.
    Suresh.

    • Hi Suresh, I’m glad that you are fine and that everything worked as we all hoped for you. You will see that you will feel great in few month as you never had Achalasia. Best regards, yours Roger

  45. Hi Roger,
    I really appreciate if you could help me to establish communication with Dr. Inoue

    I have sent him my test results several months ago, and desperately waiting to know if I need a POEM surgery and if so to schedule it as soon as possible.

    Many thanks for your kind help
    Faramarz

    • Dear Raramarz,

      Hello!
      Maybe I missed you email.
      Please send your test results to me again.
      We need particularly your Barium swallow image.

      Haruhiro Inoue, MD. Prof.

  46. Dear Dr. Inoue,

    I am grateful for your kind reply, I just sent you an email with the medical reports to haruinoue777@yahoo.co.jp (hope the email address is correct), thanks again.

    Roger, many thanks to you for establishing this most helpful medium of communication, may God bless all your efforts.

    Faramarz

  47. Hi Roger & Everyone,
    I’m a 30 year old female from India. I have diagnosed with Achalasia 2 months back.I can say this the toughest phase of my life.I not able to eat anything fluids or solids, lost 5 kgs of weight. I have done a dilatation once (30 mm), but not much improvement and my doctor advised me to go for next size i.e., 35 mm. I’m Scared now, I should go for a dilatation or POEM.I have gone this complete blog and the commends from Dr. Inoue and achalasia patients around the globe. Please help me with the below queries,

    -If i go for dilatation , will it give relief throughout my life ?
    -Can any one help me doctor who can do POEM in India ,Especially one who Trained under Dr. Inoue ?

    Nithya

    • hi, dilatation will only help you for some month, after you will have again the same problem. With POEM you will be better for much longer time or even be cured. So if you can get in touch with Dr. Inoue or some doctor he is recommending, this would help you the best.
      Best regards, Roger

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