POEM (peroral endoscopic myotomy) is an endoscopic treatment for achalasia. It employs upper endoscopy rather than traditional surgery, which involves a skin incision. The lower esophageal sphincter is too tight in patients with achalasia. The goal of all achalasia treatments is to weaken the lower esophageal sphincter. The endoscopist inserts the flexible endoscope into the esophagus while the patient is under general anesthesia. A small incision is made in the esophagus's innermost layer (the mucosa). The endoscope is then tunneled down the remaining length of the esophagus in the submucosa layer. The endoscopist cuts the muscle fibers of the lower esophageal sphincter in the lower esophagus. To finish the procedure, the endoscope is removed and the first incision in the mucosa is closed. POEM may be used to treat patients who have difficulty swallowing due to achalasia.
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