PER-ORAL ENDOSCOPIC MYOTOMY (POEM) AND PER ORAL ENDOSCOPIC PYLOROMYOTOMY (POEP) FOR COEXISTING GASTROPARESIS AND ACHALASIA IN A SINGLE PATIENT PERFORMED AS A SINGLE PROCEDURE

Background and aims:

POEM may be considered as a standard method for treatment of oesophageal achalasia and POEP represents an emerging new endoscopic method for treatment of refractory gastroparesis. We demonstrate successful concomitant POEM and POEP in a patient with co-existing achalasia (type II) and refractory gastroparesis.

Methods:

First, we performed anterior POEM by using a standard tunnelling technique with triangle knife. After finishing the POEM, we continued the procedure by an incision of gastric mucosa and created a short submucosal gastric tunnel on great curvature towards the pylorus. After 2,5 cm long pyloromyotomy we closed the incision by clips.

Results:

The length of procedure was 74 minutes and we did not experienced any adverse events. On post-operative day 1, X-ray with a water soluble contrast did not show a leak and the patient started to drink and eat. The patient was discharged on POD 3 and their symptoms (both related to achalasia and gastroparesis) improved significantly.

Conclusion:

We report possibly the first case of successful endoscopic treatment of co-existing achalasia and gastroparesis (POEM + POEP) in a single patient performed as a single procedure.