Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM)

H. Li, E. Linghu, X. Wang
2012 Endoscopy  
Cardiac mucosal penetrations occurred during peroral endoscopic myotomy (POEM) in two patients with achalasia, and were treated by fibrin sealant. Case 1 was a 27-year-old man with dysphagia for over 1 year who underwent endoscopic botulinum injection, but dysphagia reoccurred just weeks later. During tunnel establishment a penetration was caused, probably by over-electrocautery from the submucosal space to the esophageal lumen near the cardia (• " Fig. 1 a) . We sprayed fibrin sealant into the
more » ... in sealant into the distal end of the submucosal tunnel under direct endoscopic vision to ensure that the fibrin sealant fully covered the hole (• " Fig.1 b) . After 6 weeks, a repeat gastroscopy showed that the hole had healed well (• " Fig. 2) . Dysphagia was relieved, with lower esophageal sphincter pressure decreased from 63.2 mmHg before POEM to 28.0 mmHg 4 months after. Case 2 was a 38-year-old woman with dysphagia for over 7 years who received balloon dilation first, but her dysphagia was not relieved.• " Fig. 3 shows the treat-
doi:10.1055/s-0032-1309358 pmid:22622752 fatcat:t3nmpha4mjegff5mpgfvgljz54