Peroral endoscopic myotomy with simultaneous submucosal and muscle dissection in spastic esophageal disorder

Abstract

Fig. 1 A narrowed segment in the esophagus is revealed on: a esophagogastroduodenoscopy, with the standard endoscope unable to pass through the narrowing; b an endoscopic ultrasonography (EUS) image, with a thick band of muscle seen. ▶ Fig. 2 Esophagram images: a before peroral endoscopic myotomy (POEM), showing strong contractions and a narrowed lumen; b on day-1 post-POEM, showing an improvement in contrast emptying.

Initial intramuscular dissection as a rescue therapy during peroral endoscopic myotomy for achalasia patients with severe submucosal fibrosis

“…Severe submucosal fibrosis correlates with prolonged procedure duration, higher perioperative complications, and even failed POEM. Methods to overcome severe submucosal fibrosis include changing to an anterior approach, simultaneous submucosal tunnel dissection [1], open POEM [2], and initial submucosal tunneling followed by through-muscle dissection [3], with variable rates of success and complications. Here, we present a novel and successful method of initial intramuscular dissection (IIMD) in two patients with severe submucosal fibrosis where submucosal tunneling was not possible (▶ Video 1).…”