POEM (Peroral Endoscopic Myotomy)
Gastroenterology
Starting from
$4,000
Up to $11,000 depending on centre
Typical duration
5–10 days
Including pre-operative work-up
Content reviewed for medical accuracy by: Dr. Rodina Ainasoa · Medical Content Writer & Health Communications
Overview
An incisionless, natural-orifice endoscopic treatment for achalasia and other esophageal motility disorders, in which the surgeon creates a submucosal tunnel through the esophageal wall via the mouth and divides the tight lower esophageal sphincter muscle (myotomy) entirely through an endoscope — no external incisions at all. POEM is now an accepted first-line alternative to laparoscopic Heller myotomy, offered by advanced endoscopy centers at a fraction of the cost of equivalent care in the US or Western Europe.
Your case is matched to a centre on the basis of clinical outcome data, not marketing. We coordinate every step — from pre-operative work-up to post-treatment follow-up — with a dedicated care coordinator.
What's included
POEM (Peroral Endoscopic Myotomy)
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POEM vs. Laparoscopic Heller Myotomy
Both procedures divide the same tight lower oesophageal sphincter muscle to relieve achalasia, but they reach it differently. Randomised trials and meta-analyses have compared the two approaches directly, per Cleveland Clinic, Mayo Clinic, and published systematic reviews.
| Parameter | POEM (Peroral Endoscopic Myotomy) | Laparoscopic Heller Myotomy |
|---|---|---|
| What it is | The myotomy is performed entirely through an endoscope passed via the mouth: the surgeon tunnels under the oesophageal lining and divides the sphincter muscle from the inside, with no external incisions at all. | The same muscle is divided through several small abdominal incisions using laparoscopic instruments; an anti-reflux (Dor or Toupet) fundoplication wrap is usually added in the same operation. |
| Anti-reflux wrap | No fundoplication is performed, since there is no abdominal access to construct one. | A partial fundoplication wrap is typically added to reduce post-myotomy acid reflux. |
| Symptom relief (dysphagia) | A landmark randomised trial found POEM non-inferior to laparoscopic Heller myotomy with Dor fundoplication for controlling symptoms at 2-year follow-up. | Long-established durable symptom control, with decades of outcomes data supporting its efficacy in relieving dysphagia. |
| Post-procedure reflux (GERD) | Associated with a significantly higher rate of gastro-oesophageal reflux, both symptomatic and on objective testing, because no anti-reflux wrap is performed. | Lower reflux rates than POEM, attributed to the fundoplication performed at the same time as the myotomy. |
| Invasiveness & recovery | Incisionless; typically a shorter procedure time and quicker return to normal activity than laparoscopic surgery. | Minimally invasive but still requires small abdominal incisions and a somewhat longer recovery than POEM. |
The Procedure: Step by Step
POEM is performed under general anaesthesia using a flexible endoscope passed through the mouth — no abdominal incisions are made at any stage.
Mucosal entry point
The endoscopist creates a small incision in the inner lining (mucosa) of the oesophagus, well above the target muscle, to access the submucosal space.
Submucosal tunnelling
A tunnel is created between the inner lining and the muscle layer, extending down across the lower oesophageal sphincter and a short distance into the stomach wall.
Endoscopic myotomy
Working inside the tunnel, the surgeon divides the thickened circular muscle fibres of the lower oesophageal sphincter (and, for spastic disorders, a longer segment of oesophageal muscle) using an endoscopic electrosurgical knife.
Mucosal closure
The original mucosal entry point is closed with endoscopic clips, sealing the tunnel; no external incision or closure is required at any point in the procedure.
Recovery Timeline
Most patients are kept nil-by-mouth or on clear liquids initially, with inpatient observation to monitor for chest pain, fever, or signs of a leak at the closure site.
A contrast oesophagram (swallow study) is typically performed to confirm there is no leak before oral intake is advanced, usually starting with a liquid diet.
Diet is progressed from liquids to soft foods and then to a regular diet as tolerated, guided by your care team; most patients are well enough to travel home within about a week.
Follow-up includes monitoring for reflux symptoms, since POEM does not include an anti-reflux wrap; many patients are started on a proton pump inhibitor and periodically reassessed with pH testing or endoscopy.
Source: Cleveland Clinic; Mayo Clinic; American Society for Gastrointestinal Endoscopy (ASGE); published randomised trials comparing POEM and laparoscopic Heller myotomy. Individual recovery varies and is guided by your care team.
Known Risks & Limitations
- Gastro-oesophageal reflux disease is significantly more common after POEM than after Heller myotomy with fundoplication, since no anti-reflux wrap is performed during POEM; ongoing acid-suppressing medication is often needed.
- As with any endoscopic tunnelling procedure, there is a risk of mucosal perforation, bleeding, or a delayed leak at the closure site, which is why inpatient observation and a swallow study are standard before resuming oral intake.
- Capnoperitoneum or capnothorax (gas escaping into the abdominal or chest cavity during the procedure) can occur and is managed intraoperatively by the endoscopy team.
- Long-term durability beyond the initial years is still an active area of study; some patients require more than one intervention over time compared with Heller myotomy, per comparative long-term outcome studies.
- As with any procedure involving general anaesthesia, there are anaesthesia-related risks your medical team will review with you individually.
Source: Cleveland Clinic; Mayo Clinic; NCBI/StatPearls; published meta-analyses and randomised trials comparing POEM and laparoscopic Heller myotomy. No procedure is without risk; your care team will review your individual risk factors.
The CureSureMedico Care Pathway
Remote clinical review
Share your manometry, barium swallow, and endoscopy reports. Our coordination team forwards your case to a gastroenterologist experienced in POEM to confirm candidacy and recommend the most suitable approach.
Diagnostic completion & clinic matching
If high-resolution manometry or a timed barium swallow has not yet been done, your partner centre arranges it on arrival to confirm the achalasia subtype and finalise the treatment plan.
Consolidated estimate
A cost estimate covering the procedure, anaesthesia, inpatient observation, swallow study, and initial follow-up is issued before you travel.
Procedure & short-stay recovery
POEM typically requires a short inpatient stay for observation and a swallow study before diet is advanced, with your care team clearing you to travel home once oral intake is well tolerated.
Continuity of care post-return
A treatment summary — including the myotomy extent and a reflux-monitoring plan — is shared with your home gastroenterologist for ongoing follow-up.
Global cost comparison — POEM (Peroral Endoscopic Myotomy)
Average coordinated costs across our partner centres. Final pricing depends on clinical complexity and chosen hospital.
| Country | Avg. cost | vs. cheapest |
|---|---|---|
🇮🇳 India New Delhi · Chennai · Bengaluru · Hyderabad · Mumbai · Kochi | $4,500 | —chevron_right |
🇹🇷 Turkey Istanbul | $6,500 | +44%chevron_right |
🇹🇭 Thailand Bangkok · Phuket · Chiang Mai | $7,000 | +56%chevron_right |
Costs are indicative estimates and vary by procedure specifics, hospital, and clinical complexity. Request a personalised estimate for your specific case.
Frequently asked questions
Laparoscopic Heller myotomy divides the same lower esophageal sphincter muscle through small abdominal incisions and usually adds an anti-reflux (fundoplication) wrap in the same operation. POEM performs the myotomy entirely through an endoscope passed through the mouth, with no external incisions, by tunneling under the esophageal lining to reach and cut the muscle. Multiple randomized trials and meta-analyses have found POEM non-inferior to laparoscopic Heller myotomy for relieving dysphagia, with a shorter procedure and recovery, though POEM carries a higher rate of post-procedure acid reflux since no fundoplication is performed at the same time.
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