The Oregon Clinic Pioneers Less Invasive Permanent Treatment for Esophageal Achalasia

Thursday, August 18, 2011

The Oregon Clinic

One of only five medical groups in the U.S. to offer POEM technique as part of a research study

Howard Wilson (not his real name) was having dinner when he suddenly couldn’t swallow. A 79-year old Portland resident and retired engineer, Wilson was terrified.  He had never had trouble swallowing before and immediately sought medical help.

“After threading a small camera into my esophagus, my physician saw that some of the muscles were not contracting as well as they should, causing food to get stuck,” said Wilson. “Though I was having no pain, I was told the condition could get progressively worse.”

Wilson was diagnosed with achalasia, a condition characterized by swallowing difficulties, regurgitation and sometimes chest pain. It occurs when the smooth muscle layer of the esophagus doesn’t move food down the esophagus to the stomach the way it is supposed to, and the bottom of the esophagus (known as the lower esophageal sphincter) fails to relax and open. Occurring in about one in every 100,000 people per year, achalasia has no known underlying cause, though it is associated with the failure or loss of certain neurons in the wall of the esophagus. Traditional treatments for achalasia include the injection of botulinum toxin (Botox), stretching the lower esophageal sphincter with a balloon, and surgery, all of which reduce the pressure within the lower esophageal sphincter to allow easier passage of food.

In Wilson’s case, multiple Botox injections were only temporarily successful. He was limited to a diet of pureed foods. After losing 30 pounds, his doctor advised him to have the sphincter muscles of the lower esophagus surgically cut and divided, a procedure that is usually done laparoscopically via small punctures in the abdomen.

“Then I was told about a study that Dr. Christy Dunst of The Oregon Clinic was starting,” said Wilson. “She helped me compare the standard surgery with a new treatment called POEM, which she and other doctors at The Oregon Clinic are helping to evaluate. After considering the pros and cons, I became the first participant in the study. At my age, I was happy to avoid the standard procedure, which would have taken me months to recuperate from.”

Only a handful of surgeons in the U.S. are trained in POEM. The Oregon Clinic’s expertise began in 2010 when Lee L. Swanstrom, MD., director of the Gastrointestinal and Minimally Invasive Surgery (GMIS) division, traveled to Japan to train with the developer of POEM, Haruhiro (Haru) Inoue, MD. Dr. Swanstrom then taught the technique to his colleague and research co-investigator, Dr. Dunst, also with the GMIS division.

POEM, which stands for peroral endoscopic myotomy, is a less invasive permanent treatment for esophageal achalasia. It is performed under general anesthesia and involves making a tiny incision in the esophageal lining to allow passage of a flexible endoscope and other instruments into the wall of the esophagus. The surgeon uses heat to destroy the muscles of the lower esophageal sphincter and then removes the tools and closes the small incision.

Dr. Swanstrom was one of the first physicians in the U.S. to learn the POEM technique. A renowned surgeon in minimally invasive techniques, Dr. Swanstrom was part of the first team in the U.S. to perform gallbladder surgery using transgastric natural orifice transluminal endoscopic surgery (NOTES). Additionally, The Oregon Clinic is the only medical facility in Oregon and one of only five in the entire country to be involved in research to evaluate the effectiveness of the POEM procedure.  The Oregon Clinic has the largest clinical experience in POEM to date and additionally, they are teaching the technique to physicians across the U.S.

Today, thanks to Doctors Swanstrom and Dunst, Howard Wilson leads a normal life with no food restrictions. “I am so grateful. The timing of this was incredible,” he said. “There’s no comparison to the standard surgery, which would have involved a much longer recovery. Dr. Dunst and the rest of the team changed my life completely.”

Doctors Swanstrom and Dunst have, to date, performed 15 POEM procedures with no complications and excellent results. They will do a formal evaluation after 25 patients have undergone the technique. For more information or to enroll in the study, contact clinical research nurse coordinator Angi Gill, RN, at 503-281-0561.