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ACHALASIA AND PERORAL ENDOSCOPIC MYOTOMY POEM
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Figure 4.
Pneumatic dilatation
Figure 4.
Pneumatic dilatation (picture by courtesy of Ron Slagter)
Surgical myotomy
During laparoscopic Heller myotomy the outside muscle layers of the LOS are cut. Heller
myotomy is performed under general anaesthesia. Success rate is around 90%. The most
important complication is perforation of the stomach. The risk of perforation is the same
in Heller myotomy as in pneumatic dilatation. In order to prevent gastro-oesophageal
reflux, myotomy is combined with a fundoplication (Figure 5). Nowadays, myotomy can
also be performed endoscopically: peroral endoscopic myotomy (POEM).
1
This treatment
is discussed below.
Figure 5.
Heller myotomy with fundoplication
Figure 6 POEM
Retained food
Figure 5.
Heller myotomy with fundoplication (picture by courtesy of Ron Slagter)
PERORAL ENDOSCOPIC MYOTOMY (POEM)
The first POEM was performed 2008.
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POEM is performed under general anaesthesia. A
mucosal incision in the middle segment of the oesophagus is made and the submucosal
layer of the oesophagus and the cardia of the stomach endoscopically transformed into
a tunnel through which oesophageal myotomy is carried out. During the procedure, the