Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia

• Main Authors: Hak Su Kim, Hee Kyung Kim, Weon Jin Ko
• Format: Article
• Language: English
• Published: Hoon Jai Chun 2020-03-01
• Series: Clinical Endoscopy
• Subjects: esophageal achalasia; esophageal motility disorders; myotomy; peroral endoscopic myotomy
• Online Access: http://www.e-ce.org/upload/pdf/ce-2019-067.pdf

Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoid-type achalasia. 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 method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.