Kelly Haisley, Michael Antiporda, MD, Walaa Abdelmoaty, MD, MBA, Christy Dunst, MD, Lee Swanstrom, MD. Providence Portland Medical Center
Introduction: In this video, we review a case showing the thoracoscopic visualization of a long esophageal myotomy done through a per-oral endoscopic approach (POEM).
Background: The patient is a 55 year old woman with chronic pain and debilitating diffuse esophageal spasms that have been refractory to medical therapy. High resolution manometry was obtained revealing type 3 spastic achalasia affecting the entirety of the esophagus. When faced with such diffuse disease, a per-oral technique starting very high on the esophagus provides an opportunity to address the disease along its entire length through a single approach. Given the extent of this particular patient’s disease, it was determined that she would be best served by an extremely long esophageal myotomy for definitive treatment of her diffuse esophageal spasm. She was thus taken to the operating room for an endoscopic long esophageal myotomy.
Methods: The video that follows demonstrates a long esophageal myotomy by a standard POEM approach but with the addition of thoracoscopic visualization of the POEM procedure from the right chest.
Conclusion: This Case illustrates that long esophageal myotomy can be a very effective treatment option for long segment or diffuse esophageal disease or spasm, and that the procedure can safely be performed by a per-oral technique. The thoracoscopic visualization of our POEM approach is a valuable visual tool in understanding the relevant nearby anatomy while performing a POEM and gives perspective on the risk of perforation in this procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95718
Program Number: V086
Presentation Session: Flexible Endoscopy I
Presentation Type: Video
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