This case describes a 51-year-old woman with achalasia who underwent a per-oral endoscopic myotomy (POEM) with complete resolution of her symptoms post-procedure. A repeat endoscopy with optical coherence tomography (OCT) was performed post-procedure to confirm successful myotomy.
Figure 1. Optical coherence tomography in a patient with normal esophagus versus a patient with achalasia after a posterior peroral endoscopic myotomy (POEM).
OCT is an exciting new technology that allows for two-dimensional, cross-sectional imaging of the esophageal wall in vivo. This technology has been well studied in Barrett’s esophagus as a means of identifying targeted high-risk areas for biopsy or resection, but may also have an important role in the management of patients with achalasia. OCT can assess the degree of esophageal muscle thickness, identify submucosal vessels, and assess the degree of submucosal thickness. It can also demonstrate disruptions in the muscular layer in patients who have undergone a POEM procedure. Pre-POEM, OCT can be used as a means to determine the safest and most opitmal approach for the myotomy. In patients post-POEM who have persistent symptoms, OCT can be a means of determining whether an adequate myotomy was performed, and subsequently whether additional endoscopic intervention would be efficacious.
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