Physicians adopt rare procedure

BY MEGAN DEPPE | MARCH 12, 2014 5:00 AM

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Specialists from different departments in the University of Iowa Hospitals and Clinics have collaborated their expertise to provide an incision-free treatment for patients suffering from achalasia, a disorder of the esophagus tube.

Achalasia occurs when a muscle where the esophagus and stomach come together — the esophageal sphincter — does not relax as it should during swallowing.

“When the bottom part of the esophagus doesn’t relax that muscle, it builds a lot of pressure in the esophagus and takes a lot of muscle to push food through the stomach,” Iannettoni said. “It’s like getting a really bad muscle cramp that keeps constantly squeezing that doesn’t work.”

He said patients with achalasia experience heartburn and chest pain regularly when eating and for some, have unintentional weight loss.

UIHC cardiothoracic surgeon Mark Iannettoni said the institution is the first and only center to adopt POEM, or a per-oral endoscopic myotomy, in the state of Iowa, as well as one of 22 centers in the U.S. to offer it to patients.

UI cardiothoracic surgeon John Keech said the procedure uses a small tube with a light and video camera attached that enters the patient’s mouth. The doctors then make a small slit in the lining of the esophagus to divide the muscle that is restricting food passage for the patient. Keech said after the divide is made, the instrument is pulled out, and the slit is repaired.

“The benefit is immediate,” Keech said. “The patients spend one night in the hospital, and they get a swallowing test the next day and are allowed to start drinking immediately. Everyone has described there has been an immediate improvement in their swallowing.”

UIHC gastroenterologist Henning Gerke said the traditional procedure is less controlled and “sometimes risky.” He said the POEM procedure has so far seen great results, however many long-term effects are currently being studied.

Iannettoni said he believes other institutions may not have adopted this procedure because studies on the long-term effects are still being conducted. He said medical researchers in Japan do not face as many restrictions on research methods.

But thus far, the surgeries have been successful, with none of the patients who had the surgery at the UIHC reporting any negative after affects.

“Serious complications are rarer with POEM procedure, and it is less invasive,” Gerke said. “With POEM, we can go into higher portions of the esophagus than we can with the myotomy.”

Since adopting the procedure in November, four patients have undergone POEM, and there are eight others anticipating the practice.

Before this procedure, Iannettoni said patients suffering from this disease underwent an alternative procedure — a laparoscopic Heller myotomy —that requires five incisions and was considered more invasive. He said this procedure would only have short-term relief for patients, as 10 percent would experience acid reflux symptoms following the surgery.

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