ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: (On-Demand)

Video Transcription

Video Summary

In this video, a case study of a 64-year-old woman with dysphagia, weight loss, and chest pain is discussed. The patient had a history of worsening dysphagia and intermittent chest pain associated with weight loss. She was on oxycodone and fentanyl patch for back pain. High-resolution manometry showed exaggerated esophageal body contraction and incomplete lower esophageal sphincter relaxation, indicating esophagitis and gastroesophageal junction (EGJ) outflow obstruction. The patient underwent the injection of 100 units of Botox to the EGJ, which initially improved her symptoms. However, she still experienced ongoing dysphagia and chest pain. Repeat manometry showed type 2 achalasia. The patient underwent a short myotomy, which improved her symptoms. However, over time, she experienced reduced symptom improvement, chest pain, and regurgitation. A second myotomy was performed, completely cutting the LES. The patient experienced significant symptom improvement and weight gain. However, concern remains about a segment of the LES that may still be incompletely cut. Expert opinions suggest a neuromodulator for pain suppression and anxiety reduction. The patient's case illustrates the challenges and complexities of diagnosing and treating esophageal disorders.

Keywords

dysphagia

weight loss

chest pain

esophagitis

gastroesophageal junction

achalasia