Peroral Endoscopic Myotomy for the Treatment of Achalasia in a Patient with Esophageal Varices. A Case Report

Abstract

Achalasia is very uncommon, and rarely does achalasia co-exist with esophageal varices. We present a 62-year-old woman who was diagnosed with both achalasia and esophageal varices in December 2014 and had a past history of hematemesis. The patient’s achalasia symptoms’ Eckardt score was 9, and her hepatic function was Child-Pugh grade A6. After comprehensive assessment of the patient’s health and discussion of the pros and cons of various therapies for achalasia, the patient underwent a peroral endoscopic myotomy. She was symptom-free after the operation and had no recurrence of achalasia symptoms at 20-month follow-up. No adverse events were reported. Peroral endoscopic myotomy for achalasia with esophageal varices has not been previously reported in the English literature.Abbreviations: BTI: Botulinum toxin injections; EUS: Endoscopic ultrasonography; GEJ: Gastroesophageal junction; HIFU: High-intensity focused ultrasound; LHM: Laparoscopic Heller myotomy; PD: Pneumatic dilation; POEM: Peroral endoscopic myotomy; TIPS: Transjugular intrahepatic portosystemic shunt.