Pittsburgh, PA (PRWEB) May 09, 2013
A multidisciplinary team of physicians and nurses from West Penn Allegheny Health System’s(WPAHS) Institute for the Treatment of Esophageal and Thoracic Disease is the first in Pennsylvania to offer per-oral endoscopic myotomy (POEM), an innovative, minimally-invasive surgical approach to treat the swallowing disorder called achalasia.
Achalasia is a problem that affects the ability of the esophagus to move food toward the stomach. Some symptoms include regurgitation of food and difficulty swallowing. The condition is caused by a malfunctioning lower esophageal sphincter (LES). When the LES fails to relax, patients have difficulty moving food past the muscle and into the stomach. In addition, the esophageal muscle fails to squeeze in a coordinated and effective fashion, thereby compounding the symptoms of obstruction.
“These patients can’t eat well- their food tends to get stuck in the esophagus,” said Abhijit Kulkarni, MD, director of the gastroenterology lab at Allegheny General Hospital and a leader within the newly created Institute for the Treatment of Esophageal and Thoracic Disease.
Medications exist to treat achalasia and physicians have used balloons to stretch the LES, but neither of those methods tends to yield good long-term results, Dr. Kulkarni said.
In one of the most successful surgical treatments for achalasia, Heller myotomy, the outer layer of the LES and esophageal muscle are cut so that the obstruction is relieved and food can move through the esophagus and into the stomach. Heller myotomy was first performed via open surgery through the chest or abdomen and has more recently been done through four to five small incisions in the abdomen.
POEM enables physicians to effectively treat achalasia in the same way but without making any incisions in the patient’s skin. Employing the NOTES philosophy (natural orifice translumenal endoscopic surgery), physicians use an endoscope to access the esophagus via the patient’s mouth.
Surgical instruments are passed through the endoscope and the myotomy is performed internally, without disruption to the skin.
“It’s a novel approach,” said Blair Jobe, MD, Director of the WPAHS Institute for the Treatment of Esophageal and Thoracic Disease. “By eliminating the need for external incisions, we are able to speed the healing process, limit or eliminate pain, and achieve a cosmetically flawless result. Our first patient went home within 24 hours of surgery, used no pain medication and noticed a dramatic improvement in his symptoms.”
Drs. Jobe and Kulkarni joined thoracic surgeon and Co-Director of the Institute, Lana Schumacher, MD, gastroenterologist Shyam Thakkar, MD, and Toshitaka Hoppo, MD, a general surgeon specializing in esophageal surgery, on the multidisciplinary team that performed the first POEM procedure at Canonsburg General Hospital. The procedure is currently being performed as part of a clinical trial to help doctors determine if it can be an effective treatment option for achalasia in the future. Physicians expect to enroll 15 patients in the study.
According to Dr. Schumacher, the likelihood of patients developing gastroesophageal reflux may be higher after the POEM procedure compared to laparoscopic Heller myotomy.
“That’s the primary reason for nesting this novel procedure into a clinical trial with well-defined outcome measures,” Dr. Schumacher said.
Other rare but serious risks involved with the study procedure include laceration or tear to the esophagus, postoperative bleeding and failed endoscopic procedure, requiring alternative treatment.
Achalasia affects about one in 100,000 people and its cause is poorly understood. WPAHS is one of a select few medical centers in the United States offering POEM surgery. WPAHS is currently enrolling patients ages18 to 80 with an established diagnosis of achalasia and no prior surgical intervention to treat it in the POEM study. Patients must meet additional criteria and pregnant women are not eligible. Patients will be followed in the study for approximately one year. There is no compensation for participation.
For more information on the POEM trial at West Penn Allegheny Health System, contact Katherine Nega at 412-578-1343 or knega(at)wpahs(dot)org.
The Institute for the Treatment of Esophageal and Thoracic Disease at WPAHS is a comprehensive, multi-disciplinary program that focuses on the treatment of patients with lung cancer, mediastinal diseases, esophageal cancer, Barrett’s esophagus, hiatal hernia, esophageal motility disorders, gastroesophageal reflux disease, and swallowing issues such as achalasia.