This Incisionless Endoscopic Surgery Treats a Rare Swallowing Disorder

For John and Allan, Achalasia Treatment with a POEM Procedure was Life Changing

John Cuddy, a high school science teacher, is happy with his newfound ability to swallow thanks to an "incisionless" surgery that provides relief from a swallowing disorder called achalasia.

Mr. Cuddy noticed that his swallowing was impaired during a case of the flu and experienced gradual worsening over time.  “I kept further restricting my diet as it became more difficult to swallow.”

By the time Mr. Cuddy learned that the cause of his swallowing difficulty was achalasia, he required a gallon of water to get through a meal and was down 35 lbs. 

The cause of achalasia is largely unknown. Achalasia impairs the motor of the esophagus that propels food to the stomach and also causes the valve at the bottom of the esophagus to have trouble relaxing. This delays food from entering the stomach. People with achalasia experience regurgitation of undigested food, chest pain and food getting stuck in the esophagus — all putting patients in danger of malnourishment.

POEM (Per-Oral Endoscopic Myotomy) is a revolutionary endoscopic therapy for achalasia

“Treatment of achalasia involves relaxing too tight muscles that surround the lower esophagus,” said Harry Aslanian MD, advanced endoscopist, Yale New Haven Hospital (YNHH) and director of the Advanced Endoscopy Fellowship, Yale School of Medicine. “Until recently, treatment options were limited to using a high pressure balloon to stretch these muscles or surgery. Alternatively, the POEM procedure uses a small flexible tube with a camera, called an endoscope, to go through the mouth and into the lining of the esophageal wall so the surgeon can precisely cut the muscles that were interfering with swallowing.”

POEM, which has a 90 percent long-term success rate, matches the efficacy of surgery without the downtime it takes to heal an incision from outside the body.

Mr. Cuddy’s goal was to eat his typical meal by Christmas, which was a month after surgery. He noticed an immediate improvement after the POEM procedure and within two weeks post-surgery, he was able to get back to solid foods to achieve this goal. “I now rely more on gravity to get food down, so I can’t eat in a space station or upside down — but other than that I have no real food limitations. We are lucky to have great health facilities and physicians performing such intricate operations.” 

When difficulty swallowing impacts social activities, it is time to seek help

Allan Schulenburg, an elementary school music teacher, was on an almost exclusively liquid diet before diagnostic tests showed that what he was struggling with went well beyond typical acid reflux. 

“I made all the modifications I could until I couldn’t anymore. It became isolating to not be able to eat out or be as social as I wanted,” said Mr. Schulenburg. “Additionally, the first thing you see when you search achalasia is that it is incurable.” 

William Ravich, MD, an expert in esophageal motility, Yale New Haven Hospital and Yale Section, Yale School of Medicine, specializing in swallowing disorders, confirmed the diagnosis and presented Mr. Schulenburg with treatment options for his condition. They started with a balloon to stretch and expand the esophagus. When that didn’t result in long-lasting improvement, Mr. Schulenburg decided to go forward with the POEM procedure.

Post-procedure Mr. Schulenburg also experienced marked relief and is eating nearly normally, with mild residual acid reflux controlled with acid blocking medication. 

Both men emphasize how dramatically they modified their diet and lifestyle due to impaired swallowing from achalasia and urge others to seek care if they find themselves in a similar position. 

“It is amazing what people learn to live with,” said Anil Nagar, MD, advanced endoscopist, Yale New Haven Hospital and Yale School of Medicine, who is an expert in performance of the POEM procedure and submucosal endoscopy. “Once people are given back their ability to enjoy food it enhances their quality of life — making this procedure one of my favorite innovations in modern endoscopy.” 

YNHH is among a small group of advanced endoscopy centers in the United States offering this less-invasive endoscopic approach to treating swallowing disorders.