ASGE Endoscopy Live: Management of Achalasia (On-Demand) | April 2023-Case Demonstration 1

Video Transcription

Video Summary

In this video, Dr. Venkat Modayil explains and demonstrates the steps of performing a peroral endoscopic myotomy (POEM) procedure for a young female patient with achalasia type 2. The patient is treatment-naive and experiences significant dysphagia and regurgitation. Dr. Modayil starts the procedure by measuring the lower esophageal sphincter (LES) and retroflexing to rule out the presence of a tumor. He then plans a 6-7 centimeter myotomy on the esophageal side, a 2-3 centimeter myotomy on the gastric side, and an incision 2-3 centimeters above the myotomy. He begins by measuring the distensibility of the sphincter using an endo-flip balloon, and then proceeds to create a submucosal tunnel using a triangular tip knife and endocautery. He ensures the tunnel reaches the LES and performs the myotomy, carefully avoiding mucosal injury and controlling bleeding if necessary. After completing the myotomy, he measures the distensibility again to confirm an adequate response. The procedure concludes with the closure of the incision using clips. Dr. Modayil mentions post-operative management, including liquid diet progression, medication administration, and follow-up with pH testing at one year. He also addresses questions from moderators and provides insights into the procedure, such as the learning curve, discharging patients on the same day, and criteria for hospital admission. Overall, the video provides a detailed overview of the POEM procedure and discusses important considerations during the process.

Meta Tag

Instrument & Accessory Used Endoflip

Keywords

POEM procedure

achalasia type 2

dysphagia

lower esophageal sphincter

myotomy

submucosal tunnel

distensibility measurement

endoflip