Same site submucosal tunneling for a repeat per oral endoscopic myotomy: A safe and feasible option.

• Authors: Antonios N. Wehbeh, Emory University; Parit Mekaroonkamol, Emory University; Qiang Cai, Emory University
• Journal Title: World Journal of Gastrointestinal Endoscopy
• Volume: Volume 8, Number 18
• Publisher: Baishideng Publishing Group | 2016-10-16, Pages 669-673
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4253/wjge.v8.i18.669
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Achalasia; Myotomy; Per oral endoscopic myotomy; Repeat procedure; Submucosal fibrosis; Submucosal tunnel

Abstract

Per oral endoscopic myotomy (POEM) is a novel endoscopic procedure for achalasia treatment. Due to its novelty and high success rates, a repeat procedure is usually not warranted, making the feasibility and safety of such approach unknown. We report the first case of a successful repeat POEM done at the same site of a previously uncompleted POEM. An 84-year-old female with type 2 achalasia presented for a POEM procedure. The procedure was aborted at the end of tunneling and before myotomy due to hypotension, which later resolved spontaneously. POEM was re-attempted at the same site of the original tunnel 1 year afterward, and surprisingly we didn't encounter any submucosal fibrosis. The procedure felt similar to a native POEM and a myotomy was performed uneventfully. Our case is the first to suggest that submucosal tunneling during a repeat POEM can be done at the same site. Hypotension during POEM is a rare complication that should be recognized as a potential result of tension capnothorax, it can however, be managed with close supportive care.