Hybrid Peroral Endoscopic Myotomy for Achalasia with Prior Treatment Failure
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초록
Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroralendoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect theoutcome of POEM as they cause submucosal fibrosis. We report a new technique called “hybrid POEM” for the treatment ofpatients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques ofPOEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part ofthe esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcamesubmucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks ofmucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.
Abstract
Achalasia is a neurodegenerative motility disorder caused by enteric neuron damage in the lower esophageal sphincter. Peroralendoscopic myotomy (POEM) is a standard treatment method for achalasia. Previous treatment modalities may affect theoutcome of POEM as they cause submucosal fibrosis. We report a new technique called “hybrid POEM” for the treatment ofpatients with achalasia who had been previously treated with pneumatic balloon dilatation. We performed two techniques ofPOEM simultaneously, the standard POEM for the upper part of the submucosal tunnel and open POEM for the stenotic part ofthe esophagogastric junction. We dissected the mucosa and submucosa, and performed myotomy simultaneously. We overcamesubmucosal fibrosis of the esophagogastric junction, which was caused by the previous hybrid POEM treatment. The risks ofmucosal incision and technical challenge of submucosal tunneling for the fibrotic area may be reduced by hybrid POEM.
참고문헌 (8)
- Giovanni Zaninotto, "Management of achalasia in 2019", Current Opinion in Gastroenterology, 35(4), pp.356~362 (2019), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Inoue H, "Peroral endoscopic myotomy(POEM)for esophageal achalasia", Endoscopy, 42, pp.265~271 (2010)
- Wu QN, "Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures", Endoscopy, 49, pp.736~744 (2017)
- Nabi Z, "Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases", Endoscopy, 50, pp.358~370 (2018)
- Sharata A, "Peroral endoscopic myotomy(POEM)is safe and effective in the setting of prior endoscopic intervention", J Gastrointest Surg, 17, pp.1188~1192 (2013)
- Liu W, "Open peroral endoscopic myotomy for achalasia with failed Heller myotomy", Dig Endosc, 30, pp.268~269 (2018)
- Liu W, "Open peroral endoscopic myotomy(O-POEM)for the treatment of achalasia", Dis Esophagus, 30, pp.1~2 (2017)
- Liu W, "Open peroral endoscopic myotomy for the treatment of achalasia : a case series of 82 cases", Dis Esophagus, 32, pp.1~7 (2019)