Tag: myotomy

Endoscopic management of recurrent Zenker diverticula after failed surgical repairs

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Post written by Sanjay Palat, MD, from Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, USA. This case involves a 65-year-old man with a Zenker diverticulum that recurred after 2 unsuccessful surgeries, transoral staple myotomy and revisional transcervical cricopharyngeal myotomy. He noted the recurrence of dysphagia, regurgitation, and weight loss beginning 1 month after his second …

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Long per-rectal endoscopic myotomy for a case of Hirchsprung’s disease

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Post written by Akshay Kulkarni, DM, from Midas Multi-Specialty Hospital, Nagpur, India. This video case shows the procedure of per-rectal endoscopic myotomy (PREM) for a case of Hirchsprung’s disease. It was a particularly difficult case requiring a long (25 cm) myotomy, and a delayed perforation complicated recovery. However, it was successfully managed endoscopically, and the patient …

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High-resolution manometry–guided endoscopic myotomy in a case with jackhammer esophagus

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Post written by Zaheer Nabi, MD, DNB, from the Asian Institute of Gastroenterology, Hyderabad, India. In this video case, we demonstrated the technique of peroral endoscopic myotomy (POEM) in a case with Jackhammer esophagus. The highlight of the video is the selection of the appropriate length of esophageal myotomy using high-resolution esophageal manometry. The point …

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Evaluation of sling fibers and two penetrating vessels for guiding extent of the tunnel and myotomy during posterior peroral endoscopic myotomy

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Post written by Hugo Uchima, MD, from the Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, and the Endoscopic Unit, Teknon Medical Center, Barcelona, Spain. In this video, we describe the technical and anatomic endoscopic references to preserve the innermost gastric oblique fibers (sling fibers) during posterior POEM, based on the location …

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Peroral endoscopic myectomy: a novel thought to reduce recurrence after previous failed myotomy

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Post written by Zaheer Nabi, MD, DNB, from the Asian Institute of Gastroenterology, Hyderabad, India. This video case describes a novel technique of peroral endoscopic myotomy (POEM) in a patient with recurrence of symptoms after Heller’s myotomy. In this case, we performed POEM by posterior route ie, 5 o’clock. After completing myotomy, we performed a …

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A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy

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Post written by Ping-Hong Zhou, MD, from the Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China. As a novel treatment approach for achalasia, POEM has achieved satisfactory long-term effectiveness. However, there are still around 10% of patients facing treatment failure, and there are currently no clinical predictive rules that could characterize …

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Lesser curve approach to gastric peroral endoscopic myotomy

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Post written by Danny Issa, MD, from the Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA. We performed gastric peroral endoscopic myotomy (GPOEM) using a lesser curve approach on 3patients with severe gastroparesis refractory to medical therapy. Two of the patients had undergone prior GPOEM with the …

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“Posterior-like” anterior per-oral endoscopic myotomy

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Post written by Georgios Mavrogenis, MD, from the Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece. Endoscopists are free to choose between anterior of posterior based on their preference. Recent data illustrate that posterior POEM is faster and less prone to mucosal injuries. Conversely, some studies have associated anterior POEM with less post-myotomy acid reflux. We …

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Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy

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Post written by Ping-Hong Zhou, MD, PhD, from the Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China. We aimed to explore the characteristics, predictors, and management approaches of intraprocedural mucosal injury. As the mucosal flap is the only barrier between the mediastinum and esophageal lumen during per-oral endoscopic myotomy (POEM), mucosal …

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Submucosal per-oral endoscopic myotomy for a large Zenker’s diverticulum

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Post written by Valerio Balassone, MD, PhD, from the Universita Campus Bio-Medico di Roma, Rome, Italy. This is a preliminary experience with an innovative technique to treat large Zenker’s diverticulum. It demonstrates innovative tools and techniques to separate the mucosa from the septum in order to achieve a complete septum division without the concern of …

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