Peroral Endoscopic Myotomy in a Child With Achalasia Cardia

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Excerpt

A 9-year-old girl was diagnosed as type II achalasia cardia by high-resolution manometry. After discussing available treatment options, informed consent was obtained. Peroral endoscopic myotomy was performed with the child in supine position under general anesthesia. A gastroscope fitted with transparent tapered cap at distal end was used for the procedure. Steps of peroral endoscopic myotomy are the following: creation of mucosal bleb using 21 G sclerotherapy needle (solution of saline mixed with indigo carmine dye), small mucosal incision (2–3 mm) made with needle knife and enlarged using an insulated tip knife (up to 3 cm), the tunnel was entered and submucosal fibers cleared using triangular tip knife, minor bleeding was controlled using coagulation forceps, myotomy was performed—selective circular in upper part and full thickness in the lower part, mucosa was inspected for any injury and gastroesophageal junction resistance was examined, and mucosal incision was closed using endoclips. Following a barium swallow performed the next day that documented no leak, oral liquids were started. The child was discharged on the third postoperative day. She is completely asymptomatic after 2 months of follow-up. A barium swallow at 3 months revealed free flow of barium across gastroesophageal junction. The video is available as Supplemental Digital Content and can be viewed at http://links.lww.com/MPG/A902.
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