What is Achalasia?
Achalasia is a frustrating esophageal motility disorder, making it difficult for food and liquids to pass into the stomach due to a lack of relaxation in the lower sphincter muscle.Patients feel that food gets "stuck," lose weight, and suffer from pain.
The good news is that there is an advanced solution: The POEM Procedure (Peroral Endoscopic Myotomy).
Invented in Japan in 2008, this procedure is recognized as the global "Gold Standard" for treating Achalasia.
Dr. Vosko is considered one of the leading experts in Israel and globally in performing this procedure, thanks to rare manual dexterity, unique endoscopic training in Australia, and the use of the world's most advanced equipment. The procedure is performed through the mouth (without abdominal incisions), allowing for controlled cutting of the muscle and restoration of swallowing ability.
Suffering from swallowing difficulties?
To schedule a consultation and POEM suitability test, call us or fill out the short form Contact Form.
Who is this treatment for?
The treatment is intended for patients diagnosed with Achalasia (Type 1, 2, or 3) or similar esophageal motility disorders (Jackhammer esophagus).
Typical Symptoms:
- Dysphagia: Difficulty swallowing solids and liquids.
- Regurgitation: Backflow of undigested food (especially when lying down).
- Chest Pain: Sometimes accompanied by spasms.
- Weight Loss: Due to inability to eat.
Achalasia Types (Precise Diagnosis for Tailored Cutting):
The precise diagnosis is determined by High-Resolution Manometry (HRM) and is critical for treatment success:
- Type 1 (Classic): The esophagus has no movement at all. POEM success rates: over 90%.
- Type 2 (Pressurization): The most common type, where pressurized compression occurs in the esophagus. POEM has about 97% success in this type.
- Type 3 (Spastic): Achalasia accompanied by painful and spasmodic contractions. Here, POEM is the preferred solution (more effective than Heller surgery), as it allows for a long incision that neutralizes the spasms.
The great advantage of POEM is the absence of external scars and the ability to treat complex cases (like Type 3 Achalasia) that surgery struggles to resolve.
POEM is a procedure requiring coordination and manual dexterity at the highest level:
- Targeted International POEM Training
Dr. Vosko underwent dedicated clinical training for the POEM procedure at a leading center in Sydney, Australia, under Prof. Michael J. Bourke - a global key figure in advanced endoscopy. The training included exposure to a high volume of complex cases, working according to international protocols, developing manual capabilities for advanced procedures, and implementing strict clinical standards, forming the basis for safe and controlled performance.
- At the Forefront of Endoscopic Technology
Dr. Vosko serves as an instructor and medical presenter for leading international companies such as CREO Medical & Boston Scientific.
For patients, this means regular use of the most advanced endoscopic equipment, including new-generation cutting, cautery, and hemostasis systems, while meeting the world's highest safety standards.
- Advanced POEM Performance via Third Space Endoscopy
Dr. Vosko specializes in performing the POEM procedure using the "Third Space Endoscopy" technique - an advanced endoscopic approach focusing on precise work within the layers of the esophageal wall. This technique requires 3D planning of the operation area, micro-endoscopic control, and extensive accumulated experience, enabling focused treatment while maximally preserving surrounding tissues and reducing the risk of complications.
Return to enjoying food, without swallowing difficulties.
Dr. Vosko invites you for a POEM consultation.
How is the treatment carried out?
How is the consultation conducted?
The procedure takes about one to two hours under general anesthesia:
- Incisionless Access: Inserting an endoscope through the mouth and making a tiny incision in the esophageal mucosa to create an internal "tunnel."
- Myotomy (Muscle Cutting): Dr. Vosko performs a controlled cut of the esophageal muscle and the sphincter ring. The length of the cut is personalized to the diagnosed type of Achalasia.
- Closure: Closing the internal entry opening using tiny clips that dissolve or fall off on their own later.
How should I prepare for treatment?
How should I prepare for the consultation?
Good preparation is critical for esophageal cleanliness and procedure safety:
- Liquid Diet: 24-48 hours before the treatment, switch to a clear liquid diet only.
- Fasting: Full fasting (including water) about 12 hours before the procedure.
- Medications: Blood thinners must be stopped in medical consultation.
What to expect the day after? (Recovery and recuperation)
Recovery is considered easy compared to surgical operations.
- Hospitalization: Observation for one night and discharge usually the next day.
- Diet: Gradual return to eating (Liquids -> Porridge-like -> Regular) over about two weeks.
- Sensations: Mild chest pain may occur and will pass.
Are there risks or side effects?
POEM is very safe. The main risk is the appearance of reflux (heartburn) after the procedure, as the valve is opened.
In most cases, the heartburn is mild and well-controlled by a daily pill. Rare risks: infection or bleeding, usually treated during the procedure.
Information for patients from abroad (medical tourism)
The unit is equipped to receive international patients and collaborates with agents for a full logistical envelope.Direct inquiries are also welcomed for rapid and efficient coordination.
POEM is a highly sought-after procedure in medical tourism due to the high skill required.
Dr. Vosko receives patients from all over the world for Achalasia diagnosis and treatment.
For your convenience, Dr. Vosko is fluent in Hebrew, English, and Russian.
Are the results permanent, or will I need to repeat the procedure?
POEM is considered a long-term solution with excellent durability (over 10 years in studies). Unlike balloon dilation, which requires repeat procedures, most patients undergo POEM only once and enjoy lasting improvement. Recurrence of symptoms is rare.
Is the treatment covered by private insurance?
Yes, the POEM procedure is recognized by most major insurance companies in Israel as a surgical operation (even though there are no incisions). Our clinic works in collaboration with leading insurance providers, and our team will assist you in submitting the pre-approval request and reviewing your individual policy.
I am an older adult. Is there an age limit for POEM?
One of the major advantages of POEM is its safety, even for elderly patients. Because there are no abdominal incisions and recovery is rapid, it is especially suitable for patients aged 80 and above, who in the past avoided Heller myotomy due to the surgical risk.
When is it safe for me to fly abroad after the procedure?
We recommend staying in the country for monitoring for about two weeks after the procedure. The reason is to ensure there are no late complications and that you are adapting to your diet. After the first follow-up visit, in most cases you can resume flying without concern.
Can I vomit after the surgery?
An important question. Because we cut the muscle that "locks" the esophagus, the ability to vomit may change. However, the goal is to allow free passage to the stomach. If you feel nauseous in the future, it is likely the contents will be able to come up, though the sensation may be different from before.
We are with you - from the very first call, we understand that on the other end of the line is a person who may be concerned or in pain, waiting for answers. Therefore, we have built a service system that truly sees you:
- High Availability: A live service center is active Sunday-Thursday from 09:00 AM to 07:00 PM and on Fridays from 09:00 AM to 02:00 PM. In urgent cases, we are available beyond these hours.
- Direct WhatsApp Line: Do you have a question about fasting? Did you forget to ask something about your medications? Our customer service is available via WhatsApp for a quick response.
- Peace of Mind from Bureaucracy: Our team is highly experienced in working with insurance companies and supplemental health plans. We will assist you in preparing the necessary paperwork and authorizations so that you can focus entirely on your health.
Esophageal Motility Disorder Treatment - Achalasia & POEM Procedure
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