Double trouble during peroral endoscopic myotomy for achalasia cardia: myotomy to the rescue.

Abstract

Peroral endoscopic myotomy (POEM) is now the established modality of choice for achalasia cardia with good long-term efficacy [1]. Dislodgement of the distal attachment (hood) inside the tunnel is an uncommon intraoperative event. The retrieval of a dislodged hood can be troublesome at or beyond the lower esophageal sphincter (LES). Here we share a case of POEM for achalasia cardia where the patient developed a dual problem of a type II mucosal injury and dislodgement of the hood at the level of the LES that was tackled with myotomy.