ASGE Endoscopy Live: Management of Achalasia (On-Demand) | April 2023-Case Demonstration 5

Video Transcription

Video Summary

In this video, Dr. Chris Thompson performs a poem (peroral endoscopic myotomy) procedure on a 34-year-old patient with spondyloarthritis and dysphagia. The patient had previously undergone esophageal dilation and was diagnosed with type 2 achalasia. Dr. Thompson introduces his team and discusses the use of a new device called the SpeedBoat, which is bipolar and allows for cutting and microwave for hemostasis. He explains that the current device is bulky and requires a therapeutic scope, but newer devices will be compatible with a diagnostic scope. Dr. Thompson demonstrates the use of the SpeedBoat to cut and coagulate the esophageal tissue, with some difficulty due to bleeding and the device's limitations. He also discusses the use of Puristat to prevent bleeding and facilitate wound healing. He completes the myotomy and closes the incision using removable clips. The procedure is monitored using endoflip, which measures distensibility index (DI) and diameter. The DI and diameter of the esophagus improve following the myotomy. Dr. Thompson concludes by discussing the advantages and limitations of the current device and the potential improvements with newer devices.

Keywords

peroral endoscopic myotomy

spondyloarthritis

dysphagia

achalasia

SpeedBoat device

esophageal tissue cutting

microwave hemostasis