Per Oral Endoscopic Myotomy For Achalasia Cardia

by Sekhar Bonagiri | Sep 11, 2020 | | 2840 32

Background

30 years old male presented with progressive dysphagia for 3 years duration.

Diagnosis And Treatment

On upper gastrointestinal endoscopy, a dilated esophagus with retained food residue along with tight gastroesophageal junction was noted. The scope could be negotiated with moderate resistance into the stomach across the gastroesophageal junction. No growth was seen.

Esophageal manometry revealed Type III Achlasia. Peroral Endoscopic Myotomy (POEM) was done in this patient. Pre procedure, the Eckardt score was 10 ( stage III) and post POEM procedure, the patient showed significant improvement ( stage – 0).

Per Oral Endoscopic Myotomy For Achalasia Cardia

Discussion

POEM is an endoscopic procedure used to treat swallowing disorders, most commonly for Achalasia Cardia. It is regarded as the endoscopic equivalent of Heller’s Myotomy. POEM is a form of natural orifice transluminal endoscopic surgery that is completed by creating a submucosal tunnel in the lower part of esophagus to reach the inner circular muscle bundles of the LES to perform myotomy, while preserving the outer longitudinal muscle bundles. The result is decreased, resting pressure of the LES, facilitating the passage of ingested material. POEM was initially introduced to treat Achalasia by targeting the LES.

About Author –

Dr. B. Ravi Shankar, Consultant Medical Gastroenterologist, Yashoda Hospital, Hyderabad
MD, DNB, DM (Gastroenterology)