VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Salvage posterior peroral endoscopic myotomy
Figure 1. Endoscopic vision of the entrance into the tunnel by using the multipurpose knife.
Peroral endoscopy myotomy (POEM) is a highly efficacious endoscopic treatment for achalasia. Conventionally, a submucosal tunnel is fashioned in the anterior or 2 o’clock position of the esophagus. There are occasional failed POEM cases, especially in patients with significant fibrosis or scarring of submucosa from prior therapies, such as botulinum toxin injection. This video describes the case of a patient with achalasia who had an incomplete clinical response to an anterior POEM procedure because of significant fibrosis of the esophagus from prior achalasia therapies. To further treat her symptoms, we offered a salvage posterior POEM procedure in which we created a second submucosal tunnel in the 5 o’clock position (Fig. 1; Video 1, available online at www.giejournal.org). The patient’s clinical symptoms and Eckardt Scale score improved (from 7 to 4) after this procedure. Posterior POEM has a higher theoretical risk because of the proximity of the posterior esophagus to vascular structures; however, it lends itself to easier closure of the mucosal incision with endoscopic suturing because of the orientation of the instrument channels of the endoscope. In patients with failed anterior POEMs, performance of a
www.giejournal.org
posterior POEM is a reasonable option to increase the likelihood of clinical success. However, this technique should be attempted by endoscopists with significant experience in performing POEM. DISCLOSURE M. Kahaleh is a consultant for Boston Scientific and Xlumina and has done research for Gore, MI Tech, and Pinnacle. He has done research and consulting for Mauna Kea Technologies. No other financial relationships relevant to this article were disclosed. Prashant Kedia, MD, Reem Sharaiha, MD, Nikhil A. Kumta, MD, Arnon Lambroza, MD, Michel Kahaleh, MD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.04.018
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
Salvage posterior peroral endoscopic myotomy
Figure 1. Endoscopic vision of the entrance into the tunnel by using the multipurpose knife.
Peroral endoscopy myotomy (POEM) is a highly efficacious endoscopic treatment for achalasia. Conventionally, a submucosal tunnel is fashioned in the anterior or 2 o’clock position of the esophagus. There are occasional failed POEM cases, especially in patients with significant fibrosis or scarring of submucosa from prior therapies, such as botulinum toxin injection. This video describes the case of a patient with achalasia who had an incomplete clinical response to an anterior POEM procedure because of significant fibrosis of the esophagus from prior achalasia therapies. To further treat her symptoms, we offered a salvage posterior POEM procedure in which we created a second submucosal tunnel in the 5 o’clock position (Fig. 1; Video 1, available online at www.giejournal.org). The patient’s clinical symptoms and Eckardt Scale score improved (from 7 to 4) after this procedure. Posterior POEM has a higher theoretical risk because of the proximity of the posterior esophagus to vascular structures; however, it lends itself to easier closure of the mucosal incision with endoscopic suturing because of the orientation of the instrument channels of the endoscope. In patients with failed anterior POEMs, performance of a
www.giejournal.org
posterior POEM is a reasonable option to increase the likelihood of clinical success. However, this technique should be attempted by endoscopists with significant experience in performing POEM. DISCLOSURE M. Kahaleh is a consultant for Boston Scientific and Xlumina and has done research for Gore, MI Tech, and Pinnacle. He has done research and consulting for Mauna Kea Technologies. No other financial relationships relevant to this article were disclosed. Prashant Kedia, MD, Reem Sharaiha, MD, Nikhil A. Kumta, MD, Arnon Lambroza, MD, Michel Kahaleh, MD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.04.018
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
