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.
Why patients choose us
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A specialist POEM endoscopist, in a high-volume unit
Not a general therapeutic list. A named advanced endoscopist with a substantial POEM case log, in a London unit that runs a proper achalasia service.
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The right operation for your achalasia
POEM is not always the answer. For classic type II with a healthy anti-reflux profile, laparoscopic Heller + Dor is often the better call. We say so before you commit.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private POEM costs in London.
All-inclusive ranges across our partner units: consultant, anaesthetist, theatre, ward stay and follow-up. Send the manometry and we quote firm figures across two or three options.
In short
A private POEM in London, all-in: £12,000–£20,000, home after 1–2 nights.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation and manometry review | £450–£900 | 45–60 min | Same visit |
| POEM, standard achalasia type I or II | £12,000–£16,000 | 75–120 min | 1–2 nights |
| POEM, achalasia type III (spastic, long myotomy) | £14,000–£18,000 | 90–150 min | 1–2 nights |
| Redo POEM after prior Heller or pneumatic dilatation | £15,000–£20,000 | 90–150 min | 2 nights |
| Timed barium swallow and pH study package | £900–£1,600 | 2 visits | 1–2 weeks |
| Second-opinion review of manometry and endoscopy | £250–£450 | 30 min | 48 hours |
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. We come back with a firm quote within one working day.
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.
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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.
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Worried about reflux afterwards?
Post-POEM reflux is the honest trade-off. We quote your realistic PPI probability, plus TIF or LES-Clip options, before you consent.
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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.
The journey
From referral to reflux review - what happens, in order.
One team from first message to your 6 to 12 month pH study and surveillance gastroscopy.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · Admission
One to two nights on the ward
Phase 3 · After
Concierge, back on
- 01
Before
You send us your manometry and gastroscopy
A short, confidential form. High-resolution manometry (Chicago v4) subtype, gastroscopy report, timed barium swallow if you have one, and a summary of prior treatments.
- 02
Before
We come back with a recommendation
Within one working day: whether POEM fits, or whether laparoscopic Heller + Dor or a repeat pneumatic dilatation is the better call. Indicative price, an honest read either way.
- 03
Before
We arrange the admission
Usually within one to three weeks. Clear-fluid diet for 24 to 48 hours before, a bedtime fast, and anticoagulants reviewed with the team.
- 04
Admission
Admission and general anaesthetic
Arrival, consent, and a chat with the endoscopist and anaesthetist. POEM is done under a full general anaesthetic with CO2 insufflation.
- 05
Admission
The POEM itself
Around 90 minutes. Submucosal injection, a small mucosal entry in the mid-oesophagus, a submucosal tunnel down past the gastro-oesophageal junction, selective myotomy of the circular muscle, then mucosal closure with clips.
- 06
Admission
One to two nights on the ward
Overnight observation, a contrast swallow the next morning to check for leak, then clear fluids. Home the day after in most cases.
- 07
After
Follow-up and reflux surveillance
PPI on discharge. Review at 4 to 6 weeks with an Eckardt score. pH study and gastroscopy at 6 to 12 months to screen for reflux and Barrett’s.
Typical end-to-end: 1–3 weeks to procedure. Hospital stay: 1–2 nights. Full activity: 2–3 weeks.
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.
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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.
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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.
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Failed pneumatic dilatation
Symptoms back after balloon dilatation. POEM offers a definitive muscle-cut without an abdominal operation.
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Recurrence after Heller myotomy
Redo POEM through a fresh submucosal plane can rescue patients whose Heller has failed, without re-entering a scarred abdomen.
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Older patients, higher operative risk
A single-visit, incisionless procedure avoids five abdominal ports and pneumoperitoneum in patients where laparoscopy is less appealing.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Where POEM is done in London
A small panel of London units, we picked them.
POEM needs a specialist advanced endoscopist, not a general therapeutic list. In London we work with University College London Hospital Private, Royal Marsden Private, HCA London Bridge Hospital and Cromwell Hospital (Bupa Cromwell). Introductions are made privately, once we understand your case.
Selection criteria
How we choose every POEM endoscopist in our network.
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Advanced endoscopists with high POEM case volumes and formal proctorship
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Units running a proper achalasia service: manometry, timed barium swallow, pH, MDT
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Access to laparoscopic Heller + Dor and revision surgery in the same institution
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Anaesthetist-delivered general anaesthetic with CO2 insufflation as standard
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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pH study and gastroscopy at 6 to 12 months
Every POEM patient in our network is offered a pH study and a surveillance gastroscopy within a year to screen for silent reflux and Barrett’s oesophagus.
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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 quiet reminder
Endoscopy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 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.
- 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.
- 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.
- 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
Cover for POEM varies by insurer and by indication - usually funded when achalasia is confirmed on high-resolution manometry. We confirm cover before booking.
Frequently asked
Everything we get asked about POEM.
Quick answers on durability, recurrence, reflux, scars, insurance and recovery.
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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.
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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.
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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.
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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.
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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. We handle the paperwork with the unit and confirm cover before booking.
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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.
Related tests and treatments
Looking for something else?
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TIF fundoplication
Transoral incisionless fundoplication for reflux after POEM.
Learn more -
Endoscopic mucosal resection
EMR for large flat polyps and early neoplasia.
Learn more -
Endoscopic submucosal dissection
ESD for larger or deeper GI lesions.
Learn more -
Gastroscopy
Diagnostic examination of the upper GI tract.
Learn more -
Acid reflux
Reflux disease, work-up and treatment options.
Learn more
Ready to talk?
Send us your manometry and gastroscopy. We come back within one working day with an honest recommendation.
Whether POEM is right for you, or laparoscopic Heller + Dor, or a repeat pneumatic dilatation - we tell you before you commit, and introduce the London unit that fits best. Independent, and free.