Nikhil A. Kumta, MD from the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York, USA presents this video case, “Salvage posterior peroral endoscopic myotomy.”
Peroral endoscopic myotomy (POEM) is a highly efficacious endoscopic treatment for achalasia. In this video, we present a patient who had an incomplete clinical response to an anterior POEM due to significant fibrosis of the esophagus from prior botox injections. We performed a salvage POEM from a posterior approach to help alleviate her symptoms. The patient’s clinical symptoms and Eckhardt score both improved following the second procedure.
Prior endoscopic therapies such as Botox injections can lead to submucosal scarring or fibrosis, occasionally causing a failed POEM.
In patients with failed anterior POEMs, performing a posterior POEM is a reasonable option to increase the likelihood of clinical success. This technique should only be attempted by endoscopists with significant experience in performing POEM given the proximity of the posterior esophagus to vascular structures.
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