COMMENTARY

Peroral Endoscopic Myotomy for the Treatment of Achalasia

H. Alejandro Rodriguez-Garcia, MD; Monica T. Young, MD; Hope T. Jackson, MD; Brant K. Oelschlager, MD

Disclosures

March 29, 2017

Case Presentation

A 62-year-old man presents to the clinic with a 2-year history of progressive dysphagia and regurgitation. His surgical history is significant for an open abdominal aortic aneurysm repair and laparoscopic incisional hernia repair.

Barium esophagography shows esophageal dysmotility and delayed passage of barium through the gastroesophageal (GE) junction (Figure 1), and high-resolution manometry was consistent with type III achalasia (Figure 2).

After careful consideration of available treatment options, the patient decides to undergo peroral endoscopic myotomy (POEM).

Figure 1. Barium esophagography showing esophageal dysmotility with delayed contrast passage through the gastroesophageal junction.

Figure 2. High-resolution manometry showing premature contractions and a nonrelaxing lower esophageal sphincter, consistent with type III achalasia.

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