Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller's Myotomy

Muhammad Miftahussurur, Manu Tandan, Zaheer Nabi, Dadang Makmun

Research output: Contribution to journalArticle

Abstract

Achalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller's myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for Achalasia due to persistent symptoms after Heller's myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller's myotomy was performed 2 years ago. Barium swallow showed Achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as Achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an Achalasia patient who received POEM after unsuccessful Heller's myotomy and showed clinical improvement.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalCase Reports in Gastroenterology
DOIs
Publication statusAccepted/In press - 1 Jan 2020

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Cardia
Esophageal Achalasia
Deglutition
Esophagogastric Junction
Lower Esophageal Sphincter
Manometry
Barium
Pressure
Myenteric Plexus
Gastrointestinal Endoscopy
Deglutition Disorders
Therapeutics
Diet
Pain

Keywords

  • Achalasia cardia
  • Peroral endoscopic myotomy
  • Post heller's myotomy

Cite this

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Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller's Myotomy. / Miftahussurur, Muhammad; Tandan, Manu; Nabi, Zaheer; Makmun, Dadang.

In: Case Reports in Gastroenterology, 01.01.2020, p. 48-55.

Research output: Contribution to journalArticle

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