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Video Presentation - 5
Type II achalasia treated with Peroral Endoscopic Myotomy (POEM): A novel and effective alternative
Julio César Moreno Alfonso 1, María José Neira Morales 2, Esther Comajuncosas Pérez 1, Isabella Garavis Montagut 2, Catalina Fonseca Rejtman 2, Ada Molina Caballero 1, Eduardo Albéniz Arbizu 3, Alberto Pérez Martínez 4
1 Hospital Universitario de Navarra. Department of Pediatric Surgery. Doctoral School. Universidad Pública de Navarra (UPNA). Pamplona; Spain
2 Universidad El Bosque. Medical Faculty. Bogotá; Colombia
3 Hospital Universitario de Navarra. Department of Gastroenterology. Pamplona; Spain
4 Hospital Universitario de Navarra. Department of Pediatric Surgery. Pamplona; Spain
Introduction: To present, through audiovisual material, a case of achalasia successfully treated with peroral endoscopic myotomy (POEM), demonstrating the step-by-step technique.
Case presentation: A 12-year-old male initially evaluated for chest pain, who progressively developed dysphagia, was ultimately diagnosed with type II achalasia and successfully treated with POEM. The procedure was performed under general anesthesia using a 9.2 mm gastroscope with a 2.8 mm working channel. Methylene blue was injected into the posterior esophageal wall to create a submucosal bleb, over which a mucosal incision was made 10 cm above the gastroesophageal junction. Through this mucosotomy, the submucosal space was accessed, and a 11 cm submucosal tunnel was created using blunt dissection and monopolar energy, extending beyond the gastroesophageal junction. A myotomy of 4 cm in the esophagus and 2 cm in the stomach was performed, targeting the inner circular muscle layer and transitioning to a full-thickness myotomy at the lower esophageal sphincter. The mucosotomy was closed with six clips. The procedure was uneventful. The patient tolerated liquids within 24 hours and experienced symptomatic relief from the first postoperative day. Discharge occurred on postoperative day four, and at 24 months follow-up, the patient remains asymptomatic. Consent was obtained from patients and/ or legal guardians.
Conclusion: Although laparoscopic myotomy remains the gold standard for pediatric achalasia, POEM has emerged as a minimally invasive, safe, and effective alternative. Given its comparable outcomes to laparoscopic myotomy, it could be considered a first-line therapy in experienced centers.