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Liu X, Zhou Y, Jiang X, Liu L, Zhao D, Ma H, Tian H, Jiang H. Superselective arterial microcoil embolization for delayed bleeding after peroral endoscopic myotomy. J Int Med Res 2022; 50:3000605221135475. [PMID: 36348613 PMCID: PMC9659941 DOI: 10.1177/03000605221135475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/11/2022] [Indexed: 08/30/2023] Open
Abstract
Peroral endoscopic myotomy (POEM) has been shown to be an effective treatment for achalasia and with few adverse events. Only a few cases of delayed bleeding have been described. This current case report describes a patient with delayed bleeding in the submucosal tunnel on the eighth day after POEM. The patient was a 21-year-old woman with a 4-month history of dysphagia, vomiting and excessive weight loss. Achalasia was diagnosed according to her symptoms, barium oesophagogram, oesophageal manometry and endoscopy examination. POEM was performed by an experienced operator. On the eighth day after POEM, the patient suddenly developed continuous haematemesis presented with vomiting of fresh blood and melena. An emergency exploratory esophagogastroduodenoscopy was performed. A large number of blood clots were found at the wound and a long haematoma was found along the lining of the submucosal tunnel. Re-entry into the submucosal tunnel and exposure of the haemorrhagic site was attempted but failed because of severe submucosal tissue adhesion. An emergency angiography was undertaken and haemostasis was achieved with superselective arterial microcoil embolization.
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Affiliation(s)
- Xuechen Liu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Yonghong Zhou
- Department of Nutrition, Shijiazhuang Maternity and Child Healthcare Hospital, Shijiazhuang, Hebei Province, China
| | - Xiaoyu Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Li Liu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Dongqiang Zhao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Huihui Ma
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Hui Tian
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
| | - Huiqing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Centre for Digestive Diseases, Shijiazhuang, Hebei Province, China
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Giulini L, Dubecz A, Stein HJ. [Laparoscopic Heller myotomy after failed POEM and multiple balloon dilatations : Better late than never]. Chirurg 2018; 88:303-306. [PMID: 27928603 DOI: 10.1007/s00104-016-0332-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the lack of long-term results, peroral endoscopic myotomy (POEM) has been increasingly propagated as a feasible alternative to pneumatic balloon dilatation (BD) and laparoscopic Heller myotomy (LHM) in patients with achalasia. After a long-term follow-up, a large percentage of patients reported recurrence of dysphagia. It is unclear which kind of procedure (redo POEM or LHM) should be utilized in these patients with failed POEM. CASE REPORT AND RESULTS We report the case of a 37-year-old female patient with type I achalasia who was successfully treated with LHM after a failed POEM procedure. After the manometric diagnosis of type I achalasia, the patient was treated with six balloon dilatations within a period of 5 months. Because of the persistence of symptoms a POEM procedure was performed with no relief and the patient was referred for surgical treatment. An esophagography showed a pronounced widening of the middle and the distal esophagus with a persistent narrowing of the lower esophageal sphincter (LES) and because of these indications LHM was performed. The intraoperative examination revealed extensive scarring of the submucosal layer with the muscularis mucosae of the distal esophagus; nevertheless, it was possible to carry out a 5 cm long cardiomyotomy without mucosal injury. The operation was completed with a Dor fundoplication. There were no postoperative complications. After surgery the patient reported an immediate and complete relief of dysphagia. DISCUSSION AND CONCLUSION The published experiences with POEM seem to show promising short-term results in terms of dysphagia relief; however, the few available mid-term analyses demonstrated no essential advantages when compared to LHM; therefore, the LHM must still be considered the gold standard procedure for definitive treatment of achalasia. According to our case report, LHM was shown to be a safe and effective although laborious treatment option due to scarring even after failed treatment by POEM.
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Affiliation(s)
- L Giulini
- Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg, Prof. Ernst-Nathan Straße 1, 90419, Nürnberg, Deutschland.
| | - A Dubecz
- Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg, Prof. Ernst-Nathan Straße 1, 90419, Nürnberg, Deutschland
| | - H J Stein
- Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg, Prof. Ernst-Nathan Straße 1, 90419, Nürnberg, Deutschland
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Lee E, Brodsky JB, Rivas H, Zheng K, Brock-Utne JG. Capnoperitoneum During Peroral Endoscopic Myotomy-Recognition and Management: A Case Report. ACTA ACUST UNITED AC 2017; 8:145-146. [PMID: 28114155 DOI: 10.1213/xaa.0000000000000449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia. During POEM, carbon dioxide is insufflated under pressure into the esophagus and stomach, which can cause clinically significant capnoperitoneum, capnomediastinum, or capnothorax. We present a case in which gas accumulation in the abdomen during POEM had adverse effects on ventilation. Once the cause was recognized, needle decompression of the abdomen led to immediate improvement in ventilation.
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Affiliation(s)
- Eric Lee
- From the Departments of *Anesthesiology, Perioperative and Pain Medicine, and †Surgery, Division of Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, California
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