Chiaki Sato, MD, PhD, Yusuke Taniyama, MD, PhD, Tadashi Sakurai, MD, PhD, Makoto Hikage, MD, PhD, Kai Takaya, MD, PhD, Takuro Konno, MD, PhD, Ken Koseki, MD, Ryohei Ando, MD, Takeshi Naitoh, MD, PhD, Michiaki Unno, MD, PhD, Takashi Kamei, MD, PhD. Dept of surgery, Tohoku Univ Hospital
Introduction: Chest pain is a common symptom of esophageal achalasia and markedly lowers patient’s quality of life. However, some patients continue to experience chest pain after surgery, even when symptoms, such as dysphagia, have resolved. The mechanism behind chest pain caused by esophageal achalasia is poorly understood.
Case: We report the case of a 47-year-old female with residual chest pain after Heller–Dor operation whose dysphagia was resolved. High-resolution manometry (HRM) confirmed spastic simultaneous contractions in her middle esophagus. We diagnosed her as having type III achalasia, and assumed that the cause of her chest pain was incomplete myotomy of spastic simultaneous contractions in the middle esophagus. We performed the peroral endoscopic myotomy (POEM) procedure in the middle esophagus. Because she was type III achalasia, the length of the myotomy was adjusted to the length of the spastic segment in the esophagus, as observed on HRM. The POEM procedure improved her chest pain.
Conclusion: The cause of continued chest pain after surgical treatment for esophageal achalasia may be due to incomplete myotomy of the esophageal inner muscle, and POEM is effective for treating this pain.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93399
Program Number: P419
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster