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.


203 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:

        I hope this helps,

        Homero Rivas, MD, MBA, FACS
        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.


    • 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?

      • Hi have u done poem for ur son? My dad facing same issue planning for one he is 67 yrs old… Is it good alternative?

    • 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

      • My name is Gulshan Kumar aged 14 years. i have also gone through poem on year 2012,it is a very effective measure for relaxation from dysphagia in swallowing food,and severe chest pain,my operation was done by Dr santosh,he is a very good doctor,i think that he gave me a new life,b’coz i loosed 12 kgs in only 6 months so my body became totally weak,and i m also very choosy in eating so when i was suffering for achalasia it was very miserable moments for me,IF YOU ARE IN AIG THEN YOU ARE IN A RIGHT PLACE PLEASE CONTINUE YOUR OPERATION
        Yours faithfully
        Gulshan kumar

    • sir i have gone through poem by dr. amit maydoe on the 16 th .last four days i am on liquid diet .i am not getting motion and i dont know how much liquid diet i have to take .i am feeling too week..sir pls inform how many days i should be on liquid and how much quantity per day. and what i do for weekness

      • I am ragaei I have achalasia make one time balloon dilatation on 1st of last October I need to contact with professor h.anoue by email to let him make for me POEM but could not get his contact information

    • Hi Dr. Inoue, my daughter has been diagnosed when she was more than a year old but we did not pursue the operation because the doctor was unfamiliar for this type of disease because it’s rare therefore we postpone hoping that the esophagus would grow as my daughter grows older but since then we did not see any improvement in her situation and my as parents, our hearts are heavy upon seeing her vomiting after she eats. I believe this is an answered prayer for us. I’ve read you performed POEM in DLSU hospital in Philippines last year.

      I have some questions:
      Is POEM already practiced by some doctors in Philippines or any neighboring country aside from Japan? If so, approximately how much would it cost for this operation? We want her to be operated as soon as possible. She is five years old now.

      Pls reply ASAP. Thanks doc ! God bless you more…

      Manny from Philippines

    • Hello from Texas.
      Diagnosed with Hashimotos and last summer with achalasia. I had one balloon dilation last summer. I have been dealing with it as I can since then. Some good days, some bad. I am very much interested in having the POEM procedure. I am most concerned with the surgeon’s experience and proficiency with this complicated procedure. Are there experienced surgeons in the Texas area? I am also willing and able to go to Stanford or New York if I need to. (I would love to visit Japan, but unfortunately, that is not possible.) My main concern is acid reflux afterward as I had some rare and scary reactions to PPIs and will not be able to take them if necessary.

      Thank you very much for your help. Prayers and support for all who deal with achalasia.


      • I did A LOT of reaseach. I live in Chicago and had my POEM in Chicago in December 2012 with Dr. Nathaniel Soper at Northwestern Memorial Hospital. He is experienced with POEM. I have no swallowing problem now. I have occassional reflux which is well known to occur at least 30%(generally if I snack late at night or drink coffee without eating first) I take PPIs with my morning vitamins. I take liquid antacid in addition if necessary (a couple times per month if I feel some heartburn during the day or night). It is not a dysfunctional problem. It’s 1000x better than the swallowing problem. I highly recommend him. if the University of Texas Hospitals have someone who has done 30-50 POEMS, I would consider that experienced. Dr. Soper had about that many when he did mine 4 years ago and he has still been doing them.

    • Sir I have gone through poem 2 years back.can after peom we can go togym and do cardio and muscle exercise .because I started 2 month back I am feeling eating problem..

    • Thank you for this procedure. I had mine in May of 2015 by Dr. Steven Demeester professor of Thoracic Surgery at USC Keck Hospital in LA, Ca. I am doing fine and Dr. Demeester went to the Oregon Clinic in Portland, OR to continue his practice!

    • Dear Prof Haru,
      We are from Malaysia. My 16 year old son went through an endoscopic balloon dilatation in April 2017. Barely 7 weeks after the procedure, the problems returned. We were referred to a hospital in Kuala Lumpur and a manometry was done and it was established that my son was with achalasia cardia type 2. We seek your advice urgently. Please let us now if we have experiencd POEM trained experts here in Malaysia or Singapore. We await your recommendation. Thank you sir.

  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!


      • 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.




      • 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


  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!!

      • I wish your blog was translated to English. Yours is the only step by step I can find:(

  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,
      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.

      • 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

    • 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.

    • 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.

  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


  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 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,


    • 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,


  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 Do you mind sending me an email so I can discuss Soper and Hungness follow up experience with you?
    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.
    Thank you for this blog. I was more comfortable with my decision after reading about your experience. You are very generous to provide this.
    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.”

    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 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.
    2) February 2010 article by Dr. Inoue about his first 17 POEM patients.
    3) July 2012 article by Dr. Inoue, et al based on 200+ cases and summarizing results on P.8.
    4) November 2011 abstract of article by Dr. Inoue, et al regarding 16 patients.
    5) 2012 article by Dr. Ponsky, et al regarding how he performs POEM.

    Best Regards to all,

  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

    • Just found your note..I’m in qld heading to Tas to chat with doc re. This operation…your news would be great to take onboard..Jim

  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


    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.


    • 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


      • 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,


      • 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

      • 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

    • Francesca, I am now thinking about doing POEM. Please tell us how you are feeing now that more than two years have passed. Thank you for your post. I hope that you are able to report improvement.

      And thank you to all who post on this site!

  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.

    • 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.

      • 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,



  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:

      I hope this helps.

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

      Homero Rivas, MD, MBA, FACS
      @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.

      • He did mine in May 2012 but he is no longer there. He moved with a renowned Dr. named Sundstrom to the Oregon Clinic in Portland, OR and continues his practice.

      • Dave Sherwood said I am Sorry My POEM was done in May of 2015 by Dr. Steven Demeester at USC Keck Hospital in LA, CA. Dr. Demeester is now at the Oregon Clinic in Portland , OR and continues to due the POEM procedure!

  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 Also your experience with surgery and physicians, all this will help to all others with achalasia.

        Best regards and I wish you good luck,


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

  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 “”
    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.


    • Hi Rachel,

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

      Best regards,


  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.

  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.!/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

  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 I read it and it sounds great and I’m very happy for you that all went well.

        Best regards,


    • 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,


  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,


      • 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,


    • 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
      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.


    • 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,


      • 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.


      • 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,


  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.


    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.


    • 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,


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


  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…
    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

    • 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

    • Hi Vinita,

      Thanks for sharing your experience. I have drop you an email to the above said mail id . Please reply back with your inputs , it would be a great help for me.


  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.


  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.

    • 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

      • Hi Aarti,
        Yes I would recommend Dr.Inoue as he is the pioneer in this surgery. well I am unaware of any doctor who is practicing this method in Mumbai. but if travelling is an issue for you, better do some research in major hospitals in Mumbai.
        All the best.

  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

    • Dear Raramarz,

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

      Haruhiro Inoue, MD. Prof.

      • Dear Prof. Haru Inoue,
        My daughter has been diagnosed with Dysphagia and TRO Achalasia with Upper Endoscopy and Manometry Test. She is planning on scheduling a Heller’s Myotomy surgery soon. Because her condition is getting worse day by day.
        Actually the doctor informed if there are several options to treat a Achalasia, but the Endoscopy Treatment only in China, India, and Japan these days.
        I am looking for a better option for her, and finally I found this Roger’s blog.
        Yesterday I sent my daughter’s result test to your email ( &
        Please would you indicate a suitable time to meet us? For some reasons I prefer Japan than Switzerland. We will going to apply visa to Japan as soon as possible.
        Thank you very much for your kind attentions.

        Best regards,

        Thanks a lot to Roger

  46. Dear Dr. Inoue,

    I am grateful for your kind reply, I just sent you an email with the medical reports to (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.


  47. Sir,
    My mother (54 year old)is suffering from Achalasia Cardia since last 04 years. As prescribed by doctor of Global Hospital Bhopal , She takes Calci gard retard (10 mg) tablet 30 to 45 min before taking food. Some time food stuck up in food pipe and heavy chest pain during stuck and that time happens very horrible and dangerous.
    I listen about new technique Pre Oral Endoscopic Myotomy (POEM) for treatment of Achalasia Cardia. Please suggest me is this new technique is safe or not ? And please also suggest best hospital and name of doctor in India who is performing this new technique POEM successfully.
    Please reply, I will be thankful to you.

  48. 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 ?


    • 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

  49. Dear Dr. Inoue,

    I am planning a trip to Tokyo around mid January 2015, I was wondering if you would be in Tokyo at that time and if I could book an appointment to do a complete checkup on my achalasia status?
    (I have sent couple of emails regarding the same issue in the past few days)
    I appreciate your kind response.

    Best regards, Faramarz

  50. I am a 64 years old female diagnosed with achalasia 7 years ago.
    After a year of misdiagnosis I went to Mount Sinai Hospital in Miami and had a balloon dilation.I have been well for all this years but I am starting to have symptoms again and have been considering POEM.

    I have not been able to reach the list of Hospitals and Doctors performing the procedure that Epstein posted.( it says is no longer available or not authorized)

    I would like to know if someone can tell me or if Dr Inoue has the name of a trained doctor in South Florida (Miami, Fort Lauderdale, Palm Beaches, ).

    I would greatly appreciate the information.

    Thanks George for this blog and thanks to all for the testimonies

    • Dear Ana. I have achalasia, and I found this reply of yours on this blog. Did you find a doctor in South Florida that is experienced with achalasia? I am in South Florida also.

  51. Dear Mr. Roger,

    First of all, I would like to thank you for writing and managing this blog. Because of it, we managed to be in contact with Professor Haruhiro Inoue from Japan. My daughter just had POEM surgery around the middle of this month (November 2014) under Prof. Inoue at Showa University Koto Toyosu Hospital in Tokyo. It might be too early to give our review now, but so far everything seems fine, and we are very happy to see that she is recovering well and fast.

    We also would like to thank Prof. Inoue for attending to our case. Although he is very busy, he was very kind and caring to the patient. He was also very careful in making a diagnosis, and he wanted to make sure that my daughter’s case was a typical achalasia case or a more complicated one before going to the next step. Prof. Inoue ensured us that POEM is a very safe and suitable procedure to my daughter’s case. He mentioned that until now his team has performed POEM more than 700 times.

    We are very impressed that the recovery after POEM is very fast. My daughter could start to have solid food on the 4th day after the surgery. POEM may be the best option to consider when you have an achalasia.

    All the best,

  52. Hi Roger and everyone,
    I am a 41 year old female, i was diagnose with Gerd a few years back, i went to a total of 5 doctors, before i saw a mystery diagnose show on tv that featured a young lady with the same symptoms i had, i brought it o my GI attention and he send me for a few test which confirmed i had Achalasia. This went on for 2 years and i tried every herb, medication, massage, acupunture and chiropractic care, finally September of 2013, i started loosing weight rapidly, could no longer swallow or eat, i went to Winthop Hospital here in NY and met the GI director there and immediately booked to have the P.O.E.M done. The best decision i ever made, i can eat, i gained back weight, i can sleep, swallow and my skin finally loss the dehydrated look. I take protonics twice a day, still have heart burn occassionally, but i can now eat in public. I still have to do a few test such as the barium swallow, upper endoscopy. But compare to where my life was heading, i believe POEM is the close to a cure there is at the moment. I do not smoke, drink, or do drugs. There is no family history, just still hopeful, one day there will be a cure. Thank you for posting all the reponses and information on this scary disease.


  53. Hi everyone, just got back from Japan, where I had the POEM procedure, I am speechless once it comes to Japan, Japanese and Dr. Inoue, this was an experience beyond this world, a country so advanced with most disciplined, polite, honest, kind and considerate people that I have ever seen and yet most importantly Dr. Inoue a living angel whose kindness and care is most remarkable, this also goes to the entire staff of Showa University Hospital.

    Faramarz Shams

  54. I am scheduling POEM surgery with Dr. Tom DeMeester in Los Angeles in May 2014. Does anybody have recent experience with Dr. DeMeester, or know how many POEMs he has performed? Thank you very much.

    • Hey Ben – I had the procedure done with Dr DeMeester in Nov of 2013. I don’t know precisely how many he has performed, but you can surely ask him that. He’s a very competent surgeon. Mine has so far been quite successful though I do get more reflux than I would like (manageable on a PPI, but I’d love to not have to take one). Feel free to email me at w.shane.grant [at] if you want to discuss anything.

      • Hi Shane – my POEM is on Monday the 21st of December 2015 with Dr. DeMeester at USC in Los Angeles. Thanks for posting as it is nice to see someone else who went through the same thing and came through the other side better.

  55. Dear Dr Inoue
    I am 34yrs old female and diagnosed with Achalasia Cardia 2 yrs back
    I am an Indian staying in USA so I am searching for Doctors at both the places
    Please help I have three options
    Dr Stavros Stravopoulus(NY)
    Dr Amit Maydeo(India)
    Dr Nageshwar Reddy (India)
    Please help me and guide to take the decision as I am in pain and lost lot of weight
    Please suggest me one option

  56. Dear fellow Achalasia sufferers,

    This blog saved my life; it informally introduced me to Dr. Homero Rivas at Stanford Hospital who operated on me and I’ve been somewhat normal for over 2 years now!

    I can really empathize with those suffering from achalasia, it sucks. It’s such an awful and terrifying disease, especially in the early stages when you haven’t been diagnosed with it and no doctor can identify what’s causing all the weight loss, chest spasms and regurgitation. The 3 tests are also so unpleasant :-(.

    If you’re able and willing, I can’t recommend POEM enough to you as a course of treatment. It saved my life, literally. I did not undergo previous treatment (balloon dilations etc), I went straight to POEM and have had zero regrets. I understand that everyone’s bodies and circumstances are different, but if your doctor recommends POEM as a possibility, please strongly consider it.

    My surgery was performed on a Friday afternoon and I was out of the hospital the following day. I went to the movies on the Sunday; THAT’s how fast recovery was (also, watching movies requires very little physical effort 🙂 I also have zero visible scars (unlike with the laparoscopic myotomy that leaves you with a couple here and there).

    A few minor details I wish I had known before:
    – My neck was really stiff post surgery – a result of the gases used during the procedure, I’m told.
    – I had difficulty peeing for a few of hours post surgery (very uncomfortable). The anesthesia numbs your muscles, including the ones that help you urinate. Once it wears off, you’re fine.
    – I continued having chest spasms following the surgery, and naturally panicked, but they quickly disappeared on their own (thank goodness)!
    – I had a very thick glue in my belly button that I didn’t know I was allowed to wash out, after the surgery.

    Lastly, POEM does not cure you, but it SIGNIFICANTLY increases your quality of life. I still feel the sensation of food getting “stuck” every now and then, especially with nuts or dry cereals. The trick is to lubricate your esophagus with liquids and then the food should slide down with ease.

    So many friends and family members have commented on how they’ve forgotten that I have achalasia because of the ease with which I can eat most foods – it’s all thanks to POEM and my incredible surgeon + medical team.

    Roger (author of this blog post) – THANK YOU, THANK YOU, THANK YOU for creating an online forum for people with our disease to share our thoughts in writing, seek comfort in each other’s successes and encourage others to stay strong in their battle.

    Dr. Homero Rivas – THANK YOU. Can’t say it enough.

    Cheers from the SF Bay Area!

    • Meghna,
      I, too, live in the Bay Area (hooray for us!). I’m wondering if you were able to get insurance coverage for your surgery.

      Thanks for sharing your story – a great piece of encouragement for me!


    • Meghna,
      Many thanks for your kind comments. I am so glad to hear that you are doing well and that you allowed me to be part of this.
      Also thank you for creating awareness of achalasia and POEM through this great social community.

  57. Hello Roger and everyone reading Roger’s blog,
    Roger, thank you for creating and maintaining your blog which is providing important information on POEM and the doctors pioneering this groundbreaking procedure for the treatment of achalasia.

    My POEM was performed by Dr. Stavros Stavropoulos at Winthrop University Hospital in Mineola, New York (near both JFK International and LaGuardia airports) in March (2015). I am so grateful to Dr. Stavropoulos for the excellent care I received and the wonderful results I have due to his expertise in performing POEM and his passion for advanced endoscopy. Dr. Stavropoulos has performed more POEMs than any other operator in the United States (over 200 as of March 2015) and was the first to offer POEM (in 2009) outside of Japan (after performing POEMs with Dr. Inoue).

    While researching information about achalasia and treatment options available after being diagnosed at the end of 2014, I came across a site, Long Island Live Endoscopy Educational Portal: which contains videos of lectures given and endoscopic procedures performed at an advanced endoscopy course held at Winthrop University Hospital in 2013, 2014, and 2015. Although the course is really for doctors and medical students, I learned so much and got answers to my many questions about POEM by watching the lectures and POEM procedures by the most experienced POEM doctors in the world.
    After watching the course videos that contained current information on POEM, I became convinced that I wanted to have the POEM procedure because of its many advantages over other treatment options, specifically over laparoscopic Heller myotomy (LHM).

    I also knew that I wanted Dr. Stavropoulos to perform my POEM, which is one of the most important and best decisions I have ever made. All aspects of my POEM went smoothly, and I was released from the hospital the following day. My recovery was just as easy as other POEM patients have written about. I no longer have the dysphagia to liquids and solids, regurgitation, and chest pain that I had prior to POEM. I am eating well and feel so much better!

    If you have achalasia, consider POEM with Dr. Stavropoulos. You will receive excellent care with one of the most experienced POEM doctors in the world.

    Dr. Stavropoulos’s contact information:
    Stavros N. Stavropoulos, MD
    Director, GI Endoscopy
    Director, Program in Advanced GI Endoscopy (P.A.G.E.)
    Winthrop University Hospital, Mineola, NY

    Maria Marotta-Kollarus, BSN, RN
    POEM Coordinator/Research Coordinator
    Department of Gastroenterology, Hepatology & Nutrition
    Winthrop University Hospital
    1 (516) 663-4652

    For more information on the current status of POEM, see the International POEM survey white paper.

    Best regards to all,

  58. My mom aged around 70 is recently dignosed with the same problem.doctors advised to go for POEM.can you suggest me is this treatment available in kolkatta since we are from sikkim.

  59. Please give me more details about poem. I was diagnosed with achalasia since 2006. I undergo laparoscopic surgery and had balloon dilation 3 times. Until now im suffering from reflux and deprived of food and quality sleep.
    I highly appreciate reply.

    God bless!


    • Dear Marijoy,
      Hello! I am doctor Haru Inoue who developed POEM procedure. Although we need to evaluate your disease, but anyway, you may be treated by POEM. We would like to refer your barium swallow image. May we also ask you where you are living.

  60. Dear Dr Haru Inoue,
    I,m patient being diagnosed with Achalasia recently at Aug 15. I have go thru a ballon dilation once and I found seem is not cure. Is POEM procedure available in Malaysia? Who is the Doctor have perform this at Malaysia. If Malaysia not available. Is Singapore have any experience Doctor ever perform this POEM procedure?
    Appreciate you may advise and recommend me a way to cure my illness.

    Anson Kok

    • In Malasia and Singapore I do not know any expert doctor who are trained POEM adequately.
      One of my recommendation to visit Zurich (Swiss) where I myself periodically visit and perform POEM together with Prof. MD. Stefan Seewald. If you concern I can contact him.

      • Dear Prof Haru,
        We live in a small town in Malaysia. About 13 months ago,my now 16 year old son suffered badly from dysphagia and vomiting. The symptoms persisted for 8 months and he was treated for all kinds of ailments before he was diagnosed with achalasia cardia in March 2017. He went through a balloon dilatation on April 1st 2017 but the problem returned after 7 weeks. We were referred to a government hospital here in Kuala Lumpur where an endoscopy manometry was done and he was established with achalasia cardia type 2. We were advised to undergo POEM. I would very very much like to put my son in your hands to perform this surgery but am not able to go Japan due to financial constraints…please advise if we have the experts who are trained by your good self to do POEM here in Malaysia or Singapore by now 2017. Thank you.

    • Hi there Anson, so far as I’m concern there’s no doctor can perform poem in Malaysia .Im from Malaysia too ! I was diagnosed achalasia back in 2012 when I’m 22years old . I’ve done 2x balloon dilation and trust me it doesn’t work!it getting worst! The only way is u can perform surgery laparoscopic surgery in Malaysia . I’ve done it in year 2013 at prince court hospital kl under doctor Dato dr yunus .so far so good. Because as u know in Malaysia there’s no poem either spore. But if u have time and money u can fly out to Japan and do the poem. Take care buddy ! Hang in there 😉.

  61. My 13 year old son was diagnosed with achalasia 1 month ago we are waiting for a referral to see a specialist. We are located in Canada and very interested in the POEM procedure. Can anyone tell me if the POEM procedure is being performed on children in Canada or what our best options for treatment will be?
    Thank you

  62. Can a future anti-reflux procedure follow POEM if reflux occurs? Reflux is my main concern regarding POEM and I hear lots of conflicting reports and statistics regarding it’s occurrence from surgeons. I wonder if this has to do with how they gather their data (patient reports, testing, etc.). Please tell me whether or not a fundoplication or other anti-reflux procedure could follow a POEM. Thank you! Amy

    • Hello Amy,
      I underwent a successful POEM surgery in mid October of last year (2015). Though not a 100% fix, the relief has been dramatic. Without exception, since surgery, food of any kind always reaches my stomach – usually effortlessly.

      That said, and to address your concern, I have experienced acid reflux on several occasions – a few times, severe enough to wake me out of a sound sleep (not a pleasant experience!). However, this is not consistently the case. I can’t yet say why some days are better than others in this regard. My experience tells me that the literature regarding reflux should be taken fairly seriously – avoid eating if possible within two hours prior to laying down. I have, however, broken this rule at times without noticeable repercussions. Acidic things such as red wine or coffee can be problematic, though not always.

      FYI, subsequent to my surgery, I read about a hybrid POEM procedure that involves both a POEM and a dor fundoplication. I believe that the fundoplication is done by a thoracic surgeon, and thus leads you into a more invasive experience as this part can’t be done orally. I am due for my six-month follow up exam in April (next month) and will know more about the severity of my reflux issue and what steps can be taken post POEM to tamp it down.
      I hope this info helps you in your decision making process.

      • Thank you, Steph, for replying to my inquiry. I wonder if there’s a point to getting the fundoplication with POEM when I could just get it with the Heller since it would defeat the purpose of the less invasive approach of POEM. I tried to call the Mayo Clinic (is that where you heard of the hybrid procedure?) to ask about this but they won’t give out information without an appointment and I live in California. I have considered getting the POEM, waiting to see if I have a problem, and then getting a fundoplication later if there is. It’s either that or going with the Heller Myotemy with Fundoplication so I don’t have to go for another surgery. I’ve been interested in POEM because it is less invasive and it’s easier to go back in if another surgery is needed later on. But I take the reflux issue seriously because of the connection to cancer and because I’m a singer and I’ve heard of people losing their voice due to reflux. The frustrating part is that the experts give different information regarding reflux following either surgery and, especially, POEM. In the end, I know I have to gamble and hope for the best. I just wish I could get consistent information in which to make my decision! I wish you all the best and appreciate you sharing your experience with me. Amy

      • Dear Amy & Steph,

        In my opinion you don’t have to go through fundoplication, My situation of Achalasia that I’ve done Heller’s myotomy with a fundoplication and 2 years after I’ve done the POEM to get a better results that I didn’t got from Heller’s. My surgon Told me that my fundoplication was closed very tight when he went through my esophagus while performing POEM.

        So I can give you a clear vision that I did POEM and I have a very tight fundoplication and the acid reflux is still disturbing me if I filled my stomach by eating a lot of meals (4-6) a day. But I reliazed its a matter of control, you can take PPI pills 15 mins before meals twice a day (1 in the morning and 1 for the last meal before sleeping) to secure yourself from acid reflux, or you can control yourself by know how to prevent it. If red wine and coffee disturbs you then try this thing: (don’t drink them on an empty stomach.. eat 1 or 2 meals then afterwards try drinking your not gonna feel the burning hopefully)

        Also another important thing to keep in mind that fundoplication may affect the swallowing process because what it does is wrapping the upper portion of the stomach around the lower portion of the esophagus. This tightens the lower esophagus which was widened through POEM procedure. (As simple POEM=widening, Fundoplication=Tightening) So it’s not a good result if you want to experience your best swallowing.

        Eventually to all Achalasia people in this world I strongly suggest POEM procedure (WITH THE RIGHT SURGON) over all other treatments and without fundoplication if you want to experience a better swallowing process in eating.


    • Amy,
      As a post script to my earlier reply, I came across this in response to a sikilar question I asked the doctor who performed my POEM surgery:
      After surgery 30% of people will have GERD. 1/2 of these will have heartburn symptoms – the rest are silent. it is treated medically

  63. I am newly diagnosed with Achalasia and want to explore POEM. Is there a doctor referral for those who perform this procedure? I’m in St. Louis, MO.

  64. Hi
    I am considering the POEM opp and live in the UK.
    Having looked at all the post I cant find any information on the POEM procedure being carried out in the UK.
    Can anyone advise
    Thank you

    • Try Mr Amyn Haji of Kings College Hospital London. I have had a consultation at Kings with a view to having POEM performed in September.

      • Steve
        Thank you for this information.
        Do you know how many times Mr Haji has performed the POEM procedure.

  65. Hi my name is Pawan Hirawat recently in April 2016 I was diagnosed with achalasia Cardia in Asian institute of Gastroenterology Hyderabad India and I went through POEM surgery it’s been 2 months and I am feeling better in swallowing food.. But from last 1 week I feel little pain again while swallowing. Is there any chances of getting achalasia again ??? Can someone please help me

    • Hi Pawan, in my particular case I also felt sometimes after the poem procedure some chest pains, but not really because of eating, read my post weeks after the poem surgery. So if these pains after swallowing continue longer than one week, I would visit again your doctor and tell him your concerns. With poem you can not cure achalasia, you can only take care of the effects like problems of swallowing, chest pain and so on, but the esophagus on the lower part does not function anymore normal. In my case I feel again 100% normal and I do not have anymore any signs of achalasia. To me until now the procedure worked. But remember, every person does react different on any kind of procedure. Best regards and good luck. Roger

  66. Hello!
    Pawan and Roger,
    Roger, you are right. After POEM almost all patients improves their disphagia symptom. But some of them still have chest pain in some degree. It is not generally a sign of recurrrence.


  67. I too struggled with achalagia, dysphasia, ,, ( had to drink 8- 10 glasses of water every meal. I also had reflux, heart burn, and on top of this crazy disease, condition, whatever it is, a full nights sleep was absolutely impossible. Every night having to sleep sitting up because as soon as you lay flat, you would wake up couphing and regurgitating the partial dinner that was stuck in your esophagus,.absolutely miserable, tried the botox shot with minimal relief that did not last. Dialation treatment was temporary and looked painful and left you recuperating for awhile. I was given the opportunity to be part of a symposium at ceders sinai, where dr Simon Lo and Dr Inoue, I beleive, were teaching this P.O.E.M sugery. I am here today 6 months later so blessed and so thankful. I can now eat things like fruits and vegtables with no problems!! Everything passes through. I only need to drink when im thirsty!!! And also I can sleep soundly, no couphing no regurgitation, and no going to the bathroom 6-7 times a night. My reflux is completly gone I have not had any heartburn in over 4 months. I feel like I have been cured, Amazing. Now my only problem is the insurance has sent me a letter informing me that they will not pay for the procedure because there is not enough information on long term effects. …….cant win

  68. i am suffering from achalsia cardia and i need to know where i can get treated in india?cost as well any help would be appreciated tired of drinking water every time i swallow food

  69. I am scheduled for the POEM at UNC Chapel Hill on August 22 with Dr. Grimm. He has not performed this surgery on someone with gastric bypass. Has anyone had gastric bypass and then the POEM procedure? I am rather nervous. I understand a professor from Japan will be visiting this day to observe and wonder could it be Dr. Inoue???

    • Dear Lana,
      If you truly have achalasia, having a POEM after a bypass should help you a lot, and technically it should be just the same. Actually after this you should not worry at all about any potential acid reflux. On the other hand, lots a bypass patients have difficulty eating and this does not have to be related to achalasia. We have dome POEMs on several patients after bypass and their outcoues are usually good.
      Best of luck,
      Homero Rivas, MD
      Stanford University

  70. I live in San Diego and would greatly appreciate recommendations for surgeons who do the POEMS procedure. I am 31 years old otherwise healthy and was diagnosed with type II achalasia two years ago. It was manageble with nifedipine PO but over the last few months Ive been having more trouble with vomiting, choking while sleeping and would love to hear what options would be best in my case?

  71. Hello,
    My name is Wendy , I live in Edmonton, Alberta, Canada. I was diagnosed with Achalasia about 6 years ago. I have just been drinking large quantities of warm water to get my food down. I have been researching POEM and would like to have the procedure done. Is there anyone who performs POEM surgery in Canada, or do I have to go to the US? Thank you!
    Best regards

    • Please visit Dr. Robert Bechara. He is now working in Kingston close to Toronto.
      He trained in our hospital in Tokyo about one year. He did more than 30 cases as an operator.
      He is an excellent endoscopist who perform POEM in Canada as long as I know.

      • Dr Inoue

        Could you provide a name of a Dr in the United Kingdom that performs the POEM procedure.
        Thank You

  72. Dr. Homero Rivas & Dr. Inoue,
    Since the first patient was treated about 5 years ago, do we have any feedback on his/her condition today? About to make an appointment for my daughter at either Stanford or University of South Florida -Tampa (we are based in Miami).

  73. Do anyone have a poem and do not forget it (don’t help) ? The esophagus is still narrowed as before surgery. Is the second operation safe and effective? I would be grateful for any answer / opinion…

  74. Hi Dr Inoue,

    Im 24 years old and was recently diagnosed with type 2 and type 3 achalasia. I have a lot of ‘attacks’ – which i was informed were esophagal spasms, and also it is almost impossible to eat without drinking water.

    I had a knee surgery last year, after which the doctor prescribed oxycodone as a painkiller. All my achalasia symptons started after that surgery. Is there any connection with opiod painkillers and esophagal motility disorders?

    I am apprehensive to take POEM procedure because this would mean taking in more drugs. My doctor also informed me that the POEM would not completely resolve the attacks because i have type 3. I need to talk to someone about this because it is affecting me mentally and physically.

    Could you please respond to me on this email.. i would really appreciate it.


    • It is thought generally that no direct relation of opioid to esophageal motility disorders.
      In your case Type 3 (spastic) achalasia, POEM is the only treatment option to improve you from your esophageal symptoms. Haru.

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