Clin Endosc.  2016 Jul;49(4):383-386. 10.5946/ce.2015.108.

Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM

• Hong HJ
• Song GW
• Ko WJ
• Kim WH
• Hahm KB
• Hong SP
• Cho JY

• KMID: 2348259
• DOI: http://doi.org/10.5946/ce.2015.108

Abstract

With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.

Keyword

Peroral endoscopic myotomy; Esophageal achalasia; Double-scope peroral endoscopic myotomy; Novel approach

MeSH Terms

Endoscopes
Esophageal Achalasia*

Figure

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  Fig. 1. (A) Initial esophagogastroduodenoscopic image showing the dilated esophagus filled with liquid and some food materials. (B) Esophageal manometric image showing elevated lower esophageal sphincter (LES) pressure and incomplete relaxation of the LES. (C) Barium esophagogram showing the typical bird beak appearance of the LES (arrow).

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  Fig. 2. The peroral endoscopic myotomy procedure. (A) A mucosal incision was performed on the mucosal surface. (B) An endoscopic tunnel is created by using a dual knife. (C) The second endoscope is introduced after formation of the submucosal tunnel. (D) We identified the extent of the submucosal tunnel by using a second endoscope and performed transillumination. (E) Endoscopic myotomy is begun by using IT and F knives. (F) After myotomy, the mucosal incision is closed by using endoscopic clips.

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