Title: First Clinical Experience of Submucosal Endoscopic Esophageal Myotomy for Esophageal Achalasia with No Skin Incision
Abstract: Background: Gold standard therapeutic approach for esophageal achalasia is recently laparoscopic Heller-Dor myotomy. But it still demands at least 5 abdominal skin incisions for trocar placement. Pasricha et al. reported a method of submucosal endoscopic esophageal myotomy with no skin incision in experimental model. We conducted preliminary clinical application of modified Pascricha technique as per-oral endoscopic myotomy (POEM) for esophageal achalasia. Methods: In the middle part of the esophagus 3-cm longitudinal mucosal incision was put as a mucosal entry to submucosal space. Submucosal tunnel was created down to gastric cardia by the techniques of ESD using triangle-tip knife. Inner circular muscle bundle was dissected from 3 cm distal to mucosal entry. Dissection continued down to gastric cardia inducing total 7-cm length inner circular muscle defect. Thickened esophageal muscle bundle was totally dissected. Mucosal entry was closed using endoscopic clipping device. Clinical application of POEM was approved by IRB in Showa University Northern Yokohama Hospital. Informed consent was obtained from the patient. Results: Thirty-six year-old male who had a two-year lasting symptom of dysphasia received POEM. Barium swallowing study before and after procedure demonstrated total releasing of thickened LES. Operating time was 120 minutes in total. Post-operative course was uneventful. Dysphagia symptom totally disappeared after procedure. Conclusions: First successful clinical case of POEM was reported. This result supports further clinical application of POEM. Long-term results should be followed carefully in the future.
Publication Year: 2009
Publication Date: 2009-04-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 59
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