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Therapeutic endoscopy · London

POEM (peroral endoscopic myotomy) for achalasia - private in London.

A single-visit, incisionless operation for achalasia. Done from inside the oesophagus by an advanced endoscopist with a high POEM case volume, in a London unit with a full achalasia service and laparoscopic backup in the same building.

A stethoscope on a clinical desk

Indicative pricing

What a private POEM costs in London.

All-inclusive ranges across UK units: consultant, anaesthetist, theatre, ward stay and follow-up.

In short

A private POEM in London, all-in: £12,000–£20,000, home after 1–2 nights.

Procedure Indicative range
Consultation and manometry review £450–£900
POEM, standard achalasia type I or II £12,000–£16,000
POEM, achalasia type III (spastic, long myotomy) £14,000–£18,000
Redo POEM after prior Heller or pneumatic dilatation £15,000–£20,000
Timed barium swallow and pH study package £900–£1,600
Second-opinion review of manometry and endoscopy £250–£450

Prices vary by unit, by the operating endoscopist, by achalasia subtype (type III needs a longer myotomy and theatre slot), and by whether you have had prior treatment.

The problem

The right operation for your subtype - in the right unit.

Achalasia is treatable, but the best answer depends on your Chicago v4 subtype, your reflux risk and what you have already had. POEM is not the answer for everyone. We stop the wrong operation being booked.

  • Is POEM the right operation for me?

    Type III (spastic) achalasia and recurrence after Heller favour POEM. Type II with a healthy anti-reflux profile often does just as well with laparoscopic Heller + Dor.

  • Want it done in a proper achalasia unit?

    A named advanced endoscopist with a high POEM volume, high-resolution manometry on site, and laparoscopic surgical backup in the same institution.

Who it fits

When POEM is the right step - and when it is not.

The manometric and clinical patterns we see most often, plus the red flags that mean a pseudo-achalasia work-up comes before any myotomy is planned.

  • Type III (spastic) achalasia

    The clearest indication for POEM. A long tailored myotomy addresses the spastic distal oesophagus in a way laparoscopic Heller cannot match.

  • Type I and type II achalasia

    POEM works well across all Chicago v4 subtypes, with Eckardt success comparable to laparoscopic Heller myotomy at two years.

  • Failed pneumatic dilatation

    Symptoms back after balloon dilatation. POEM offers a definitive muscle-cut without an abdominal operation.

  • Recurrence after Heller myotomy

    Redo POEM through a fresh submucosal plane can rescue patients whose Heller has failed, without re-entering a scarred abdomen.

  • Older patients, higher operative risk

    A single-visit, incisionless procedure avoids five abdominal ports and pneumoperitoneum in patients where laparoscopy is less appealing.

  • Patient preference: no external scars

    A valid reason on its own for many patients. Everything is done from inside the oesophagus, so there is nothing to see on the abdominal wall.

  • Jackhammer or distal oesophageal spasm

    Selected non-achalasia spastic disorders with disabling symptoms and confirmed manometric findings are treated with a long POEM in specialist hands.

  • Red flag: weight loss + new dysphagia over 50

    Not automatically achalasia. A pseudo-achalasia work-up (CT, EUS, biopsy) comes before any myotomy is planned.

Procedure options

POEM sits alongside Heller myotomy and pneumatic dilatation.

What each option on the table actually involves - and which fits which patient. For sigmoid end-stage oesophagus, oesophagectomy may be discussed instead.

  • POEM (peroral endoscopic myotomy)

    Incisionless. A submucosal tunnel is created through a gastroscope, and the circular muscle of the lower oesophagus and cardia is cut. Roughly 6 to 8 cm of oesophageal muscle plus 2 cm on the gastric side.

  • Laparoscopic Heller + Dor fundoplication

    Five small abdominal incisions, an anterior myotomy of the lower oesophageal sphincter, and a partial anterior wrap to protect against reflux. Two to three nights in hospital.

  • Pneumatic dilatation

    Graded balloon dilatation of the lower oesophageal sphincter under sedation. Simpler and cheaper, but repeat treatments are common and durability is lower than surgery or POEM.

  • Botulinum toxin injection

    Endoscopic injection of botulinum toxin into the sphincter. Short-lived (three to six months), reserved for frail patients or as a bridge.

  • Selective circular myotomy

    Only the inner circular muscle is cut, sparing the outer longitudinal layer. Reduces post-POEM reflux compared with full-thickness myotomy in most series.

  • Anterior vs posterior tunnel

    The submucosal tunnel can be made anteriorly (2 o’clock) or posteriorly (5 o’clock). Two-year outcomes are equivalent; unit preference and prior surgery decide.

  • POEM plus TIF or LES-Clip

    Some centres add a transoral incisionless fundoplication or a LES-clip device to counter the higher reflux rate after POEM. Data is early but promising.

  • Second-opinion review

    A specialist review of your manometry, gastroscopy and timed barium swallow. Sometimes the right answer is repeat dilatation or watchful waiting, not another operation.

POEM vs Heller + Dor

Two good operations. Same result, different trade-offs.

Randomised data show similar symptom control at two years. The honest differences are the reflux rate and whether you want abdominal incisions.

POEM Laparoscopic Heller + Dor
Access Endoscopic, no external incisions Five small abdominal ports
Anaesthetic General, CO2 insufflation General, pneumoperitoneum
Hospital stay 1–2 nights 2–3 nights
Symptom control at 2 years 85–95% Eckardt < 3 85–95% Eckardt < 3
Post-op reflux (pH-proven) 30–50%, most on long-term PPI 15–20% (partial fundoplication)
Best fit Type III, redo cases, no scars Type II, patients wanting an anti-reflux wrap

In practice, type III achalasia, redo cases and patients who value the lack of external scars usually go for POEM. Younger patients with type II achalasia and no reflux who accept an abdominal operation often prefer laparoscopic Heller + Dor. Neither is wrong.

Safety, recovery and reflux

What to expect afterwards - honestly.

POEM is a well-established therapeutic operation. The things worth planning are your anaesthetic, the diet ramp, the PPI on discharge, and the reflux surveillance at 6 to 12 months.

  • General anaesthetic with CO2 insufflation

    POEM is always done under a full general anaesthetic. CO2 (never air) is used because any escape into the mediastinum, chest or abdomen is reabsorbed quickly.

  • Capnothorax and capnoperitoneum

    Small pockets of CO2 tracking outside the oesophagus are common and usually clinically silent. A tension pneumothorax needing a drain is rare but planned for.

  • Post-POEM reflux is common

    Around 30 to 50% develop pathological acid reflux on pH testing. Most patients stay on a long-term PPI. This is the main trade-off versus Heller + Dor.

  • Mucosotomy and leak

    Small mucosal defects during tunnelling are usually closed with clips at the time. A true leak is uncommon and picked up on the day-one contrast swallow.

  • Bleeding within the tunnel

    Managed with coagulation graspers during the procedure. Late bleeding is rare because the mucosa is intact once the entry is clipped.

  • Clear-fluid diet for 24 to 48 hours

    Clear fluids only for the first day, then soft, moist food for a week. Written instructions on what to eat and what to avoid come with your discharge summary.

  • PPI on discharge

    A twice-daily proton-pump inhibitor from day one. Do not stop it before your 4 to 6 week review, even if you feel well.

  • Red flags after discharge

    Severe chest pain, breathlessness, fever, vomiting blood or a swollen neck (surgical emphysema) - call the unit or attend A&E the same day.

Reading your operation note

Your POEM note in four parts. Read the last one first.

Whichever unit does it, the operation note the endoscopist sends you keeps to the same shape.

A London gastroenterologist reviewing a POEM operation note

A quiet reminder

Endoscopy language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Achalasia subtype and prior treatments

    Chicago v4 subtype (I, II or III), Eckardt score before and after, and a list of any prior dilatations, Heller myotomies or botulinum injections.

  2. 02 Technique

    Tunnel, myotomy length, closure

    Anterior or posterior tunnel, length of oesophageal and gastric myotomy, whether the myotomy was selective circular, and number of clips used to close the entry.

  3. 03 Findings

    Intra-procedure events and completeness

    Any mucosotomy, capnothorax, bleeding, and the endoscopist’s judgement that the sphincter has been fully divided down to the gastric sling fibres.

  4. 04 Impression

    Reflux plan and follow-up interval

    Read this first: PPI dose, diet advice, when the contrast swallow is booked, and the date of your first Eckardt-scored review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for POEM varies by insurer and by indication - usually funded when achalasia is confirmed on high-resolution manometry.

Frequently asked

Everything we get asked about POEM.

Quick answers on durability, recurrence, reflux, scars, insurance and recovery.

  • Is POEM a definitive treatment for achalasia?

    Yes. In pooled series and randomised comparisons with laparoscopic Heller myotomy, POEM reduces the Eckardt score below 3 in around 85 to 95% of patients at two years, comparable to Heller and superior to a single pneumatic dilatation. Longer-term data at five to ten years shows sustained control in most patients.

  • What is the risk of recurrence?

    Symptoms return in roughly 10 to 20% of patients within five years. Most are managed with a repeat pneumatic dilatation or, in selected cases, a redo POEM through a fresh submucosal plane. Long-standing type III achalasia and end-stage sigmoid oesophagus carry the highest failure rates.

  • How common is reflux after POEM?

    Common. Around 30 to 50% of patients have pathological acid reflux on 24-hour pH testing after POEM, which is higher than after Heller + Dor (roughly 15 to 20%). Most people need long-term proton-pump inhibitors. Some units add TIF or LES-Clip to reduce this - discuss it before you consent.

  • Will I have any external scars?

    No. Everything is done from inside the oesophagus through a standard gastroscope. There are no abdominal incisions, no laparoscopic ports and nothing to see on the chest or abdominal wall.

  • Will private medical insurance cover POEM?

    Increasingly yes. Bupa, AXA Health, Vitality, Aviva, WPA, Cigna and Healix will usually fund POEM when achalasia is confirmed on high-resolution manometry and pre-authorisation is submitted with the procedure code.

  • How long is recovery and when can I get back to work?

    You are usually in hospital for one to two nights. Clear fluids for 24 to 48 hours, then soft food for the first week. Most patients return to office-based work within a week and to full activity, including gym and travel, within two to three weeks.

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