Abstract
Introduction:
Favorable early results have established peroral endoscopic myotomy (POEM) as a safe and effective treatment for achalasia. 1 Current data suggest it results in similar perioperative outcomes when compared with laparoscopic Heller myotomy. 2 Although long-term data are currently unavailable, a prospective, international, multicenter clinical trial has demonstrated effectiveness after a mean follow-up period of 10 months. 3 Herein we provide a video demonstration (5 minutes 31 seconds) of POEM in a 61-year-old female with 9 months of progressive dysphagia and a 20-pound weight loss. Preoperative upper gastrointestinal and esophageal manometry were consistent with achalasia; esophagogastroduodenoscopy ruled out the presence of additional esophageal pathology.
Materials and Methods:
After induction of general anesthesia, the abdomen was prepped and draped. The esophagus and stomach were suctioned and irrigated with a simethicone solution. Indigo carmine dye was injected into the anterior submucosal space 13 cm proximal to the gastroesophageal (GE) junction. A mucosotomy was created using needle knife electrocautery and the submucosal space was entered with an obliquely capped standard gastroscope. Using electrocautery and blunt dissection, a submucosal tunnel was created distally until the anterior stomach wall was reached. To confirm the extent of the dissection, indigo carmine dye was injected into the tunnel and visualized in the gastric cardia submucoa from within the gastric lumen. Electrocautery was used to incise the circular muscle fibers from 8 cm above the GE junction to the gastric cardia. The submucosal tunnel was irrigated with an antibiotic solution before closure of the mucosotomy with endoscopic clips.
Results and Conclusions:
The patient described underwent successful POEM for the treatment of achalasia without complications. At a follow-up period of 6 months, she was without symptoms of dysphagia, heartburn, or reflux. Consistent with the current literature, this case report strengthens the claim that POEM is a safe and effective treatment for achalasia. Additional studies are required to establish its long-term durability.
No competing financial interests exist.
Runtime of video: 5 mins 31 secs
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