POEM post-Heller myotomy: when endoscopy is the solution

Abstract Text A 33 year-old patient with non-specified achalasia (conventional manometry), who underwent Heller myotomy, presented with reappearance of symptomatology (Eckardt score 5) five years later. Upper endoscopy showed annular constriction of esophagogastric transition, which could be passed with difficulty. Esophageal transit revealed an epiphrenic ampulla in its terminal portion and esophageal emptying difficulty. Esophageal manometry showed esophageal aperistalsis, compatible with type II achalasia, with IRP<15 mmHg. The patient underwent a posterior approach of peroral endoscopic myotomy. There was an improvement of symptoms (Eckardt score 0) until today (10 month follow-up). [1]