Peroral endoscopic myotomy (POEM) for the treatment of a rare type III achalasia

Overview

Achalasia is a relatively rare motility disorder of the esophagus characterized by atypical or the absence of, peristalsis and a defective relaxation of the lower esophageal sphincter (LES). This results in impaired bolus transportation and stasis of food in the esophagus. Traditionally, achalasia had been classified as classic (aperistalsis) and vigorous achalasia (simultaneous contractions). At present, a new Chicago Classification of esophageal motility disorders has been introduced. According to this system, achalasia can be distinguished in three subtypes due to results of high-resolution manometry (HMR): type I – ‘classic type’ without peristalsis; type II – the most frequent type, with pressurisation of the esophageal body, and type III (rarest) – with spastic contractions. Type III is characterized by the worst results of different types of treatment, especially of endoscopic balloon dilatation. Etiology of the disease is still unknown and the aim of treatment is to relieve the functional obstruction at the level of LES (for example: balloon dilatation, Heller myotomy, or new peroral endoscopic myotomy – POEM). This case report describes a polymorbid patient with rare type III achalasia (the first diagnosed patient in the Czech Republic), who was successfully treated with the endoscopic technique – POEM.

Key words:
achalasia – high-resolution manometry – peroral endoscopic myotomy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
12. 7. 2013

Accepted:
23. 7. 2013