Per oral endoscopic myotomy (POEM) in a COVID-19 patient

Abstract

Background: SARS-COV2 pandemic had a great impact on our life. Changes had been done to accommodate the current situation. Infection control measures in the endoscopy units had entirely changed. Also, prioritizations of different procedures had changed especially in the lockdown time. Peroral Endoscopic Myotomy (POEM) is considered a low priority endoscopic procedure. Case presentation: We report a 12-year-old child complaining of dysphagia and weight loss who was diagnosed as Type II achalasia. She underwent POEM. According to our Egyptian protocol; COVID-19 was excluded pre-procedural. After POEM, immediately post-procedural chest X-ray was done as usual, and it showed a shadow in the right lung base. Accordingly, HRCT of the chest was done and it showed bilateral asymmetrical patchy areas of ground-glass opacities in the posterior segments of both lower lung lobes (CO-RADS 4). PCR for COVID-19 was positive. Conclusion: We report a very unique COVID-19 case that raises many challengeable issues and shows a useful message about the risk of silent COVID-19 infection in children during the endoscopy. Keywords: achalasia; Poem; 3rd Space endoscopy; COVID-19.