Case report: Per oral endoscopic myotomy (POEM) during pregnancy
Abstract Esophageal achalasia is the most frequent primary motor disorder of the esophagus, resulting in a peristalsis and failed relaxation of the lower esophageal sphincter (LES). Various treatments have been described. Endoscopic alternatives include botulinum toxin injection and pneumatic balloo...
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Wiley
2023-03-01
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| Series: | Clinical Case Reports |
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| Online Access: | https://doi.org/10.1002/ccr3.7147 |
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| author | Ricardo J. Mejía Josefina Sáez Ricardo A. Quitral Hugo A. Monrroy Cristian G. Belmar Allan C. Sharp |
| author_facet | Ricardo J. Mejía Josefina Sáez Ricardo A. Quitral Hugo A. Monrroy Cristian G. Belmar Allan C. Sharp |
| author_sort | Ricardo J. Mejía |
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| description | Abstract Esophageal achalasia is the most frequent primary motor disorder of the esophagus, resulting in a peristalsis and failed relaxation of the lower esophageal sphincter (LES). Various treatments have been described. Endoscopic alternatives include botulinum toxin injection and pneumatic balloon dilation, but both tend to fail with time and usually repeated interventions are required. Laparoscopic Heller myotomy (LHM) has been considered the gold standard. The diagnosis of achalasia during pregnancy is extremely rare and optimal management remains unclear. Our aim was to report a successful per oral endoscopic myotomy (POEM) performed during pregnancy. A 40‐year‐old pregnant woman presented with esophageal achalasia during her first trimester. Her disease was diagnosed with high resolution esophageal manometry (HREM). Initially an expectant conduct was attempted, but dysphagia progressed during the first 6 weeks of follow‐up and an important weight loss was noticed. She underwent POEM at 15 weeks of gestation. After the procedure, she reported relief of both dysphagia and regurgitation, and her nutritional status improved. She delivered a healthy boy at term. During follow‐up, she remains without dysphagia, her upper GI endoscopy shows no esophagitis and her HREM reports a normal integrated relaxation pressure. In achalasia, as in other clinical conditions, therapeutic decisions during pregnancy should always consider both the welfare of the mother and the fetus. POEM is a purely endoscopic treatment and has been recognized as a safe procedure to treat achalasia, with postoperative clinical success comparable to LHM and potential benefits over it. |
| format | Article |
| id | doaj-art-5670880f0628403bba78b56cf638f6f6 |
| institution | OA Journals |
| issn | 2050-0904 |
| language | English |
| publishDate | 2023-03-01 |
| publisher | Wiley |
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| series | Clinical Case Reports |
| spelling | doaj-art-5670880f0628403bba78b56cf638f6f62025-08-20T02:36:46ZengWileyClinical Case Reports2050-09042023-03-01113n/an/a10.1002/ccr3.7147Case report: Per oral endoscopic myotomy (POEM) during pregnancyRicardo J. Mejía0Josefina Sáez1Ricardo A. Quitral2Hugo A. Monrroy3Cristian G. Belmar4Allan C. Sharp5Digestive Surgery Department Pontificia Universidad Católica de Chile Santiago ChilePediatric Surgery Section Pontificia Universidad Católica de Chile Santiago ChileFaculty of Medicine Pontificia Universidad Católica de Chile Santiago ChileGastroenterology Department Pontificia Universidad Católica de Chile Santiago ChileObstetrics and Gynecology Division Pontificia Universidad Católica de Chile Santiago ChileDigestive Surgery Department Pontificia Universidad Católica de Chile Santiago ChileAbstract Esophageal achalasia is the most frequent primary motor disorder of the esophagus, resulting in a peristalsis and failed relaxation of the lower esophageal sphincter (LES). Various treatments have been described. Endoscopic alternatives include botulinum toxin injection and pneumatic balloon dilation, but both tend to fail with time and usually repeated interventions are required. Laparoscopic Heller myotomy (LHM) has been considered the gold standard. The diagnosis of achalasia during pregnancy is extremely rare and optimal management remains unclear. Our aim was to report a successful per oral endoscopic myotomy (POEM) performed during pregnancy. A 40‐year‐old pregnant woman presented with esophageal achalasia during her first trimester. Her disease was diagnosed with high resolution esophageal manometry (HREM). Initially an expectant conduct was attempted, but dysphagia progressed during the first 6 weeks of follow‐up and an important weight loss was noticed. She underwent POEM at 15 weeks of gestation. After the procedure, she reported relief of both dysphagia and regurgitation, and her nutritional status improved. She delivered a healthy boy at term. During follow‐up, she remains without dysphagia, her upper GI endoscopy shows no esophagitis and her HREM reports a normal integrated relaxation pressure. In achalasia, as in other clinical conditions, therapeutic decisions during pregnancy should always consider both the welfare of the mother and the fetus. POEM is a purely endoscopic treatment and has been recognized as a safe procedure to treat achalasia, with postoperative clinical success comparable to LHM and potential benefits over it.https://doi.org/10.1002/ccr3.7147esophageal achalasiamyotomypregnancysurgical endoscopytherapeutics |
| spellingShingle | Ricardo J. Mejía Josefina Sáez Ricardo A. Quitral Hugo A. Monrroy Cristian G. Belmar Allan C. Sharp Case report: Per oral endoscopic myotomy (POEM) during pregnancy Clinical Case Reports esophageal achalasia myotomy pregnancy surgical endoscopy therapeutics |
| title | Case report: Per oral endoscopic myotomy (POEM) during pregnancy |
| title_full | Case report: Per oral endoscopic myotomy (POEM) during pregnancy |
| title_fullStr | Case report: Per oral endoscopic myotomy (POEM) during pregnancy |
| title_full_unstemmed | Case report: Per oral endoscopic myotomy (POEM) during pregnancy |
| title_short | Case report: Per oral endoscopic myotomy (POEM) during pregnancy |
| title_sort | case report per oral endoscopic myotomy poem during pregnancy |
| topic | esophageal achalasia myotomy pregnancy surgical endoscopy therapeutics |
| url | https://doi.org/10.1002/ccr3.7147 |
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