Journal List > Korean J Gastroenterol > v.64(6) > 1007314

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

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.

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Fig. 1.
The initial esophagogastroduodenoscopy. Severe esophageal contraction during the insertion is noted.
kjg-64-370f1.tif
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.
kjg-64-370f2.tif
Fig. 3.
The initial endoscopic ultrasonography. Esophageal inner circular muscle is thickened by 6 mm at mid to lower esophagus level.
kjg-64-370f3.tif
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.
kjg-64-370f4.tif
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.
kjg-64-370f5.tif
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