ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: LIVE and Virtual

Video Transcription

Video Summary

In this video, a 64-year-old woman with dysphagia, weight loss, and chest pain is discussed. She had a history of worsening dysphagia and intermittent chest pain associated with weight loss. The patient was on oxycodone and fentanyl patch for back pain. High-resolution manometry was performed, showing exaggerated esophageal body contraction and incomplete LES relaxation. The initial diagnosis was EGJ outflow obstruction. The patient was referred to an esophageal specialist who performed an endoscopy and found a low sensibility index, similar to achalasia. Botox was injected into the G-junction and the patient saw improvement. However, over time, the Botox effect faded and the patient developed chest pain again. At this point, a second myotomy was performed, this time with a posterior approach. The patient experienced significant improvement in symptoms and weight gain. However, there continued to be concerns about the incomplete myotomy and the patient's long-term use of opioids. The case and treatment options were discussed in detail, including the use of neuromodulators and the challenges associated with managing patients on opioids. The patient's long-term prognosis and treatment plan were still being monitored.

Keywords

dysphagia

weight loss

chest pain

achalasia

Botox

myotomy