Recurrent Dysphagia and Esophageal Bleeding in Patients with Achalasia After POEM

5 May 2024 04:00 05:30
Guangdong
Yinglian Xiao Host

Case 1: Recurrent Dysphagia in a Patient with Achalasia After POEM

Patient Profile & Clinical History

  • Patient: 64-year-old man

  • History: Progressively worsened dysphagia for 6 years, diagnosed as achalasia.

  • Initial Treatment: Complete symptom relief achieved by peroral endoscopic myotomy (POEM).

  • Recurrence: Dysphagia with regurgitation recurred after 2 years.

  • Medical Treatment: Symptoms did not respond to acid-suppressive therapy and prokinetics.

Examination at Initial Visit

  • Gastroscopy.

  • High-resolution manometry and barium esophagram.

Examination for Recurrent Dysphagia

  • Gastroscopy and barium esophagram.

  • High-resolution manometry.

Presenter of the Case

Mengyu Zhang, MD PhD (Guangzhou)

Case 2: Is Esophageal Stenosis After POEM Truly Achalasia Recurrence?

Patient Profile & Clinical History

  • Patient: 49-year-old woman

  • History: Dysphagia, vomiting, regurgitation and loss of appetite for 1 year.

  • Initial Diagnosis: Diagnosed with achalasia according to gastroscopy and barium esophagram in another center.

  • Initial Treatment: Underwent POEM.

  • Recurrence: Recurrent dysphagia and regurgitation 1 year after POEM.

Examination at Initial Visit

  • Gastroscopy.

  • Barium esophagram.

Examination for Recurrent Symptoms

  • Gastroscopy.

  • Histological Examination: No neoplasia.

  • High-resolution manometry and barium esophagram.

Presenter of the Case

Qianjun Zhuang MD PhD (Guangzhou)

Case 3: Recurrent Esophageal Bleeding After POEM

Patient Profile & Clinical History

  • Patient: 58-year-old man

  • History: Swallow discomfort since the 1990s, which could be relieved by a fluid diet.

  • Progression: Aggravated dysphagia 2 years ago, diagnosed as achalasia in another center.

  • Treatment Decision: Invasive treatment was refused.

  • Emergency Presentation: Patient was admitted to the emergency room for epigastric pain and melena.

  • POEM: POEM was performed, followed by slight dysphagia, regurgitation and chest pain every day, but the symptoms were tolerable.

  • Recurrence: The patient presented to the emergency room again for epigastric pain and melena after 3 years.

Examination at Initial Visit

  • Gastroscopy and barium esophagram.

Examination at Recurrent Presentation

  • Gastroscopy.

Panel for Discussion

Pinghong Zhou (Shanghai) | Ian Huang (Hong Kong) | Nina Zhang (Nanjing) | Xuelian Xiang (Wuhan) | Xiangbing Xing (Guangzhou) | John O. Clarke (Stanford) | George Triadafilopoulos (Houston) | Mehnaz Shafi (Houston)

Topics for Discussion

  1. Different causes of recurrent dysphagia in treated achalasia.

  2. How to identify different causes of recurrent dysphagia in treated achalasia?

  3. Management of recurrent dysphagia in treated achalasia.

  4. Optimized treatment for achalasia with different features.