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Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique
Recent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures.Red dichromatic imaging in peroral endoscopic myotomy: a novel image-enhancing technique
A 40-year-old man presented with a 1-year history of difficulty in swallowing liquids and solids. His Eckhart’s score was 6 of 12. EGD showed dilated esophagus with liquid stasis and mild resistance noted across the gastroesophageal junction. Esophageal manometry showed elevated integrated relaxation pressure with panesophageal pressurization (achalasia cardia type II). Peroral endoscopic myotomy (POEM) was planned and was performed using the novel Evis X1 endoscopy (Olympus Corporation, Tokyo, Japan) system.Leiomyomatosis masquerading as sigmoid achalasia: a rare occurrence
A 34-year-old man presented with an 8-year history of dysphagia to solids and regurgitation. Evaluation by using timed barium swallow and esophageal manometry suggested a diagnosis of type I achalasia with a sigmoid configuration of the esophagus (Fig. 1). Gastroscopy revealed a dilated and tortuous esophagus with no significant resistance at the gastroesophageal junction. Peroral endoscopic myotomy was performed in this case via the posterior route (5 o’clock) using the standard technique.High-resolution manometry–guided endoscopic myotomy in a case with jackhammer esophagus
A 35-year-old man presented with a 3-year history of intermittent chest pain, dysphagia, and regurgitation (Eckardt score: 5). Gastroscopy and barium esophagogram revealed a normal-diameter esophagus with tertiary contractions in the mid and lower esophagus and no resistance at the gastroesophageal junction (GEJ) (Fig. 1). High-resolution manometry (HRM) showed a high distal contractile integral of 28,013 mm Hg/s/cm in >20% swallows, with a normal integrated relaxation pressure (12.8 mm Hg) and distal latency (7 seconds), suggestive of jackhammer esophagus (JHE) (Fig. 2).Peroral endoscopic myectomy: a novel thought to reduce recurrence after previous failed myotomy
A 45-year-old man presented with a history of dysphagia and regurgitation for 8 years. He was diagnosed with type II achalasia cardia and underwent Heller’s myotomy without fundoplication 4 years earlier. The results of the present evaluation, including symptom analysis, EGD, timed barium esophagogram, and esophageal manometry, suggested a relapse. Treatment options were discussed, and peroral endoscopic myotomy (POEM) was performed. The posterior route (5 o’clock) was chosen for POEM to avoid possible submucosal fibrosis along the anterior route.Peroral endoscopic myotomy in a patient with failed Heller’s myotomy by use of a novel bipolar radiofrequency device
A 35-year-old woman presented with symptoms of dysphagia, regurgitation, and occasional chest pain for the previous 6 years. She was known to have type II achalasia and gave a history of laparoscopic Heller’s myotomy without fundoplication about 5 years earlier. Subsequently, she underwent pneumatic balloon dilatation (single session, 35 mm) for recurrent symptoms about a year after the Heller’s procedure. The present evaluation revealed a high integrated relaxation pressure and significant stasis on a timed barium swallow study.Per-oral endoscopic myotomy with endoscopic septum division in a case of achalasia with large epiphrenic diverticulum
A 75-year-old man presented to our institution with symptoms of dysphagia and regurgitation. Evaluation with EGD, barium swallow, and esophageal manometry revealed achalasia cardia with a large esophageal epiphrenic diverticulum (EED) (Figs. 1 and 2). Endoscopic myotomy was performed in this case (Video 1, available online at www.VideoGIE.org ).
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