Open peroral endoscopic myotomy for achalasia with sigmoid-shaped esophagus

Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia

“…3 Morphological changes in the esophagus can make endoscopic tunneling more difficult and time consuming. 6,7 Liu et al…”

“…investigated the "open POEM", which was performed directly without a submucosal tunnel to treat sigmoid-type achalasia 7 and was successfully performed without procedural side effects, resulting in a post-open POEM Eckardt score of 2. These cases have even reported the technical efficacy and feasibility of POEM in patients with advanced achalasia; however, these cases are especially challenging and only experienced operators should perform these procedures.…”

Double open per‐oral endoscopic myotomy (D‐O‐POEM) for the treatment of achalasia

“…[2][3][4][5][6] To avoid these repeated interventions, per-oral endoscopic dual myotomy (dual POEM), in which dual myotomy are conducted during a single procedure, has become a useful method for patients with achalasia who have severe esophageal dilatation. 8 Inspired by the success of an open POEM (O-POEM) without submucosal tunneling, [9][10][11] A 49-year-old woman was admitted to our hospital with a history of dysphagia, retrosternal pain and regurgitation that had lasted for 10 years, and the worsening of her symptoms had been noted over the previous year. She was diagnosed with achalasia with an Eckardt score of 12.…”

“…To avoid these repeated interventions, per‐oral endoscopic dual myotomy (dual POEM), in which dual myotomy are conducted during a single procedure, has become a useful method for patients with achalasia who have severe esophageal dilatation . Inspired by the success of an open POEM (O‐POEM) without submucosal tunneling, we used a double O‐POEM (D‐O‐POEM) technique in which double myotomy procedures were performed under direct visualization and mucosal defects were left open.…”

Fluoroscopy-guided peroral endoscopic myotomy for sigmoid-type achalasia

“…Sigmoid-type achalasia poses a therapeutic challenge because of its many acute angulations before reaching the EGJ [2]. Liu et al [3] performed open POEM as an easier and less time-consuming technique for sigmoid-shaped esophagus. Fluoroscopyguided POEM is an efficient technique for objectively investigating anatomically challenging locations.…”