How do you counsel patients on acid reflux post-POEM?

This is a good question. In our practice, first, we always educate patients on the front end about the risk of GERD following the POEM procedure, so that patients are aware. Second, at the same time pre-procedure, we also tell them that regardless of how they are feeling post-POEM (such as if the POEM is being done for achalasia and even if their swallowing has markedly improved), they still do need to follow up with us afterwards so that we can assess both the swallowing and GERD aspects. It is not uncommon for patients who have had POEM to have more severe GERD endoscopically and objectively (via pH testing) than they may be able to sense due to the impact of achalasia and POEM on the surrounding nerves/sensory function. In our practice, ...