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Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia

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초록

Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEMprocedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique thatis divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtypeachalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM methodcan also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change oftreatment failure.

Abstract

Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEMprocedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique thatis divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtypeachalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM methodcan also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change oftreatment failure.

참고문헌 (7)

  1. von Renteln D, "Peroral endoscopic myotomy for the treatment of achalasia : a prospective single center study", Am J Gastroenterol, 107, pp.411~417 (2012)
  2. Inoue H, "First clinical experience of submucosal endoscopic esophageal myotomy for esophageal achalasia with no skin incision", Gastrointest Endosc, 69, pp.AB122~ (2009)
  3. Lv L, "Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia : outcomes with a minimum follow-up of 12 months", Eur J Gastroenterol Hepatol, 28, pp.30~36 (2016)
  4. 김원희, "Comparison of the Outcomes of Peroral Endoscopic Myotomy for Achalasia According to Manometric Subtype", Gut and Liver, 11(5), pp.642~647 (2017), 거트앤리버 소화기연관학회협의회
  5. Wu QN, "Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures", Endoscopy, 49, pp.736~744 (2017)
  6. Hu JW, "Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus : long-term outcomes from a prospective, single-center study", Surg Endosc, 29, pp.2841~2850 (2015)
  7. Liu W, "Open peroral endoscopic myotomy for achalasia with sigmoid-shaped esophagus", Endoscopy, 49, pp.E311~E312 (2017)

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