Baylor University Medical Center Performs First POEM Procedures in Texas

Incision-free investigational surgery a growing trend for esophageal problems

A surgeon on the medical staff at Baylor University Medical Center (Baylor Dallas) recently performed two peroral endoscopic myotomies (POEM) as part of a clinical trial, marking the first time that this minimally invasive technique has been done in Texas. The two procedures involved patients with achalasia, a rare disorder that prevents proper digestion.

The POEM procedure has grown quickly in popularity worldwide over the past six years. As an incision-free alternative to surgery, the POEM technique represents a larger trend in endoscopic surgery, or "through-the-mouth" procedures.

"This procedure is a major step for surgeons performing surgery without incisions," said Steven Leeds, M.D., an esophageal surgeon on the medical staff of Baylor University Medical Center's Department of Minimally Invasive Surgery. "Surgical endoscopy is paving the way for many new procedures, and the POEM procedure is only the tip of the iceberg."

Because this surgery is new to Baylor Dallas, the surgeon performed the procedures as part of a research study through Baylor Research Institute to monitor and evaluate the technique. One of the patients who underwent the procedure did so as an alternative to the Heller myotomy, which is the standard achalasia surgery that requires either an abdominal or chest incision. The other POEM patient had completed the Heller myotomy by a chest approach in 2010 before swallowing difficulties recurred post-surgery.

Achalasia affects about one person in 100,000 per year and happens when someone's valve at the end of their esophagus is unable to relax. As a result, it causes the sphincter (a muscle that acts as the body's gateway for the passage of food and water, and a natural reflux barrier) to remain closed, which causes digestion problems. Symptoms can include regurgitation, weight loss, chest pain and the feeling that "food won't go down."

The POEM procedure takes a camera-equipped tube, called an endoscope, through the mouth into the esophagus. From there, a small hole is made in the lining of the esophagus and the endoscope travels along the muscle layer passing the lower sphincter. There, the layer of muscle causing the obstruction is cut to allow passage of food. The small hole in the esophageal lining is then repaired and the endoscope is removed.

"The procedure is shorter in duration and requires minimal instrumentation," Dr. Leeds said. "And since the POEM procedure does not require access through the abdomen or chest, there is no risk for injuring intra-abdominal organs, especially in patients with previous surgeries."

On the heels of Baylor Dallas' successful POEM procedures, physicians expect more surgical endoscopies (POEM included) for patients battling esophageal issues. As Dr. Leeds noted, the minimally invasive technique generally affords patients reduced pain, faster recovery and equivalent ability to swallow, compared to the traditional Heller myotomy.

"They usually leave the hospital without needing pain medications and have no post-operative activity restrictions and minimal diet restrictions," he said. "For the Heller myotomy, patients usually had two days in the hospital and required IV and oral pain medications with a curtailed diet for at least two weeks following surgery. With POEM, most of the patients feel as though they had an upper endoscopy, which entails no pain. They can likely go home the day of surgery, but as a precaution we keep them overnight."

Baylor Dallas is one of the few hospitals worldwide to offer participation in the clinical trial for the POEM procedure.

"This procedure is growing rapidly around the world and is a gateway into many other endoscopic procedures that will continue to flood the surgical community," he said. "Most likely, the Heller myotomy will be taken over by this procedure. Patients will all be offered this procedure as a standard of practice where appropriate."

The surgical team performed the inaugural POEM procedures under the live lens of a recorded camera. The resulting videos were made available to all Baylor Dallas staff, students and residents for training purposes with the patients' permission.

# # #

MEDIA CONTACT:
Kristine Hughes
kristine.hughes@baylorhealth.edu
office: (214) 820-7556
cell: (214) 755-0010

About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform – MyBSWHealth. Through 51 hospitals and more than 1,200 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans. For more information, visit: BSWHealth.com