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CASE REPORT

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

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Naning Shen, Xin Wang, Xiaoyin Zhang, Liping Yao, Huahong Xie, Hongbo Zhang
State key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Disease and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’ an, China.

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.262.wan

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.
Key words: achalasia – esophageal and gastric varices – liver cirrhosis – peroral endoscopic myotomy.
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.