Distal esophageal spasm with multiple esophageal diverticula successfully treated by peroral endoscopic myotomy
Tóm tắt
Distal esophageal spasm (DES) is a primary esophageal motility disorder. We encountered a rare case of DES accompanied by multiple esophageal diverticula. A 72-year-old woman complained of prolonged dysphagia and chest pain. A barium esophagogram showed multiple esophageal diverticula and significant contraction of the lower esophagus just above the cardia. Esophagogastroduodenoscopy revealed a corkscrew-like appearance, with spiral contractions and diverticula. High-resolution manometry revealed that the integrated relaxation pressure was normal; premature contractions were observed in ≥20% of the swallowing wave; the distal contractile integral was normal. She was diagnosed with DES according to the Chicago classification v 3.0. As smooth muscle relaxants were not effective, we decided to perform peroral endoscopic myotomy (POEM) to eliminate persistent esophageal contraction. After POEM treatment, her symptoms were markedly improved, and the Eckardt score significantly decreased from 11 points to 1. An esophagogram after POEM showed that barium flowed promptly into the stomach. The multiple esophageal diverticula were considered to be the result of false pulsion diverticulosis caused by excessive internal esophageal pressure, and this represented the most severe form of DES. POEM could be a new curative strategy for the most severe DES cases with multiple diverticula.
Tài liệu tham khảo
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.
Pandolfino JE, Roman S, Carlson D, Luger D, Bidari K, Boris L, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology. 2011;141(2):469–75.
Crozier RE, Glick ME, Gibb SP, Ellis FH Jr, Veerman JM. Acid-provoked esophageal spasm as a cause of noncardiac chest pain. Am J Gastroenterol. 1991;86(11):1576–80.
Fox M, Sweis R, Wong T, Anggiansah A. Sildenafil relieves symptoms and normalizes motility in patients with oesophageal spasm: a report of two cases. Neurogastroenterol Motil. 2007;19(10):798–803.
Vanuytsel T, Bisschops R, Farre R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–1121.e2.
Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.
Hoppo T, Thakkar SJ, Schumacher LY, Komatsu Y, Choe S, Shetty A, et al. A utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders. Surg Endosc. 2016;30(1):233–44.
Matsumoto H, Kubota H, Higashida M, Manabe N, Haruma K, Hirai T. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. Int J Surg Case Rep. 2015;13:79–83.
Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, et al. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc. 2009;23(6):1337–41.
Vicentine FP, Herbella FA, Silva LC, Patti MG. High resolution manometry findings in patients with esophageal epiphrenic diverticula. Am Surg. 2011;77(12):1661–4.