Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy

Abstract

m A 79-year-old woman was admitted to our hospital with dysphagia and chest pain that she had experienced for 20 years (Eckardt score: 7).1 A barium swallow examination howed a corkscrew appearance characteristic of diffuse sophageal spasm (DES) (Fig. 1A). Esophageal manomery showed simultaneous and multiple peaked contracions associated with more than 20% of wet swallows, hereas mean the simultaneous contraction amplitude as over 30 mm Hg (Fig. 1B). Therefore, the patient eceived a diagnosis of DES.2,3 With no response after 6 months of medical therapy with calcium channel blockers, a peroral endoscopic myotomy (POEM) was performed4 (Fig. 2A-C) with approval from the institutional review board of Fukuoka University Hospital and with the written informed consent of the patient. In this case, simultaneous contractions were observed in the upper thoracic esophagus. A long esophagomyo-