Jackhammer Esophagus Treated by a Peroral Endoscopic Myotomy

Weon Jin Ko; Byoung Moo Lee; Won Young Park; Jin Nyoung Kim; Jun-Hyung Cho; Tae Hee Lee; Su Jin Hong; Joo Young Cho

doi:10.4166/kjg.2014.64.6.370

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Ko, Lee, Park, Kim, Cho, Lee, Hong, and Cho: Jackhammer Esophagus Treated by a Peroral Endoscopic Myotomy

Case Report

Korean J Gastroenterol 2014;64(6):370-374.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.6.370

Jackhammer Esophagus Treated by a Peroral Endoscopic Myotomy

Weon Jin Ko, Byoung Moo Lee, Won Young Park, Jin Nyoung Kim, Jun-Hyung Cho, Tae Hee Lee, Su Jin Hong¹, Joo Young Cho

Digestive Disease Center, Soonchunhyang University Hospital Seoul, Seoul, Korea

¹Digestive Disease Center, Soonchunhyang University Hospital Bucheon, Bucheon, Korea

Correspondence to: Joo Young Cho, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital Seoul, 59 Daesagwan-ro, Yongsan- gu, Seoul 140-743, Korea. Tel: +82-2-709-9210, Fax: +82-2-709-9696, E-mail: cjy6695@dreamwiz.com

Received 12 June 20143 July 2014 Accepted 4 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 49-year-old woman visited our hospital with dysphagia and chest pain. In another hospital, she was diagnosed as reflux esophagitis. Although she had taken proton pump inhibitor and prokinetics drugs for a long time, she was not relieved of any symptoms. On the basis of high resolution manometry and endoscopic ultrasonography findings, Jackhammer esophagus was diagnosed. In this patient, peroral endoscopic myotomy (POEM) was performed for long myotomy of thickened circular muscle. During the procedure, there were no significant complications and she was discharged uneventfully. Symptoms were completely improved during three months after POEM. Here, we report on a case of Jackhammer esophagus treated by POEM.

Keywords: Jackhammer esophagus, Peroral endoscopic myotomy, High resolution manometry, Endoscopic ultrasonography

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Fig. 1.

The initial esophagogastroduodenoscopy. Severe esophageal contraction during the insertion is noted.

Fig. 2.

The initial high resolution manometry. Abnormal pressure increase is noted below the mid-esophagus in several swallows. Mean distal contractile integral: 28,449 mmHg- s-cm, normal range: 500–5,000 mmHg- s-cm. Distal esophageal contraction pressure: 406 mmHg, normal range: 43–152 mmHg.

Fig. 3.

The initial endoscopic ultrasonography. Esophageal inner circular muscle is thickened by 6 mm at mid to lower esophagus level.

Fig. 4.

Peroral endoscopic myotomy of 15-cm length is performed on the part with thickened esophageal circular muscle indicated by endoscopic ultrasonography and increased pressure by high resolution manometry. Black arrows with double heads indicate the area with myotomy.

Fig. 5.

Follow up high resolution manometry. Normal pattern is noted. Mean distal contractile integral after peroral endoscopic myotomy: 1,658 mmHg-s-cm, normal range: 500–5,000 mmHg-s-cm. Distal esophageal contraction pressure:64.8 mmHg, normal range: 43–152 mmHg.

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