Transoral endoscopic myotomy surgery is performed at Policlinico San Marco to treat a rare esophageal disease

The man operated on at Policlinico San Marco was suffering from a severe form of esophageal achalasia, a rare disease with the main symptom of dysphagia for both food and liquids. 

"This condition is characterized by a disorder in the muscles of the esophagus that do not contract in a coordinated manner. In practice, the lower esophageal sphincter (cardia), or the valve between the esophagus and stomach, remains contracted and does not release, thus preventing the natural transit of food from the esophagus to the stomach. 

The consequence is stagnation of food material in the esophageal lumen, which over time causes progressive dilatation of the esophagus and can lead, as in the case of the patient we operated on, to a total inability to feed normally," explains Dr. Francesco Azzolini, a gastroenterologist and endoscopist at Policlinico San Marco, Head of the Functional Unit of Endoscopy at IRCCS Ospedale San Raffaele, who performed the procedure.

So, the decision to undergo surgery was made. "The surgery was necessary because the disease was at an advanced stage. In addition, the patient had already undergone a complex “rescue” surgery years ago, which was perfectly successful, but was followed by a recurrence that caused his esophagus to be in severe distress. He wouldn't be able to tolerate a new surgery," the specialist continued. 

Dr. Azzolini, in agreement with Professor Stefano Olmi, head of the General and Oncologic Surgery Unit at Policlinico San Marco and Associate Professor of General Surgery at Vita-Salute San Raffaele University in Milan, therefore decided to subject the man to a per oral endoscopic myotomy or POEM surgery, an innovative technique considered the Gold standard in cases like these, performed, however, only in centers equipped with very advanced endoscopic equipment. 

In fact, there are 3 hospitals in Italy that routinely perform it, one of which is IRCCS Ospedale San Raffaele in Milan, which, with the Gastroenterology and Digestive Endoscopy Unit directed by Professor Silvio Danese, is its regional reference center. 

The great advantage of this technique is that no incisions and “cuts” are needed on the abdomen or chest, and everything is done totally from the inside, which results in:

• minimal invasiveness;
• less stress;
• reduced postoperative pain. 

"Basically, just as is done in a normal gastroscopy, the surgeon enters orally with an endoscope equipped with appropriate accessories, and accesses the esophagus where, with 3 or 4 very small holes, the surgeon goes to dissect the musculature above the valve, thus restoring its physiological release mechanism."  

The surgery is perfectly successful. After a few days, the patient can return home and start a normal life again. 

“This is the first time such an intervention has been performed in the Bergamo area,” Dr. Azzolini and Professor Olmi emphasize. – “This is an achievement that makes us proud. It was gained through: 

• synergy and teamwork, in the interest of the patient, between the 2 endoscopy and surgical teams;
• experience gained at IRCCS Ospedale San Raffaele;
• availability of high technologies, including 4K endoscopes, that allow emphasizing and magnifying the image while offering the highest possible level of accuracy."