Korean J Gastroenterol.  2018 Mar;71(3):173-177. 10.4166/kjg.2018.71.3.173.

Peroral Endoscopic Myotomy in Esophagogastric Junction Outflow Obstruction

• Kim SE
• Park MI
• Jung K

• KMID: 2407675
• DOI: http://doi.org/10.4166/kjg.2018.71.3.173

Abstract

No abstract available.

MeSH Terms

Esophagogastric Junction*

Figure

• 

  Fig. 1. The initial examination findings. (A) The initial upper endoscopy shows a contracted esophagogastric junction. (B) The initial chest computerized tomography shows diffuse mild luminal distension without distal obstructive lesion at the esophagus. (C) The initial esophagogram shows a distal esophageal narrowing with impaired contrast flow. (D) The initial HRM shows an increased IRP (black arrow) and normal peristalsis (white arrow). HRM, high-resolution manometry; IRP, integrated relaxation pressure.

• 

  Fig. 2. Peroral endoscopic myotomy. (A) Submucosal tunnel. (B) Termination of endoscopic myotomy. (C) The entry site is closed with a clipping device.

• 

  Fig. 3. The follow-up examination findings. (A) Follow-up upper endoscopy shows a small scar (arrow) at the entry site. (B) Follow-up esophagogram shows an improved contrast flow disturbance. (C) Follow-up HRM shows a decreased IRP (black arrow) and weak peristalsis (white arrow). HRM, high-resolution manometry; IRP, integrated relaxation pressure.

Reference

References

1. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991; 261(4 Pt 1):G677–G684.

2. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: abdominal and management of achalasia. Am J Gastroenterol. 2013; 108:1238–1249.

3. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago classification. J Clin Gastroenterol. 2008; 42:627–635.

4. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high abdominal esophageal pressure topography. Neurogastroenterol Motil. 2012; 24(Suppl 1):57–65.

5. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago abdominal of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015; 27:160–174.

6. Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology. 2013; 145:954–965.

7. Zheng E, Gideon RM, Sloan J, Katz PO. Esophagogastric junction outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit. Dis Esophagus. 2017; 30:1–4.

8. Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg. 2009; 13:2219–2225.

9. Ihara E, Muta K, Fukaura K, Nakamura K. Diagnosis and abdominal strategy of achalasia subtypes and esophagogastric junction outflow obstruction based on high-resolution manometry. Digestion. 2017; 95:29–35.

10. Pérez-Fernández MT, Santander C, Marinero A, Burgos-Santamaría D, Chavarria-Herbozo C. Characterization and follow-up of abdominal junction outflow obstruction detected by high abdominal manometry. Neurogastroenterol Motil. 2016; 28:116–126.

11. Okeke FC, Raja S, Lynch KL, et al. What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil. 2017; 29.

12. Muta K, Ihara E, Fukaura K, Tsuchida O, Ochiai T, Nakamura K. Effects of acotiamide on the esophageal motility function in abdominals with esophageal motility disorders: a pilot study. Digestion. 2016; 94:9–16.

13. van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015; 27:1310–1316.