Achalasia cardia can be an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller’s myotomy is the main treatment of choice due to a lower failure rate. a significant improvement and esophageal manometry exhibited that this basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an achalasia patient who received POEM after unsuccessful Heller’s myotomy and showed clinical improvement. strong class=”kwd-title” Keywords: Achalasia cardia, Peroral endoscopic myotomy, Post Heller’s myotomy Introduction Achalasia cardia is usually a neurodegenerative disorder of the esophageal myenteric plexus characterized by absence of or incomplete lower esophageal MLN8237 inhibitor database sphincter relaxation and esophageal aperistalsis, resulting in symptoms such as dysphagia, regurgitation, and chest pain. In achalasia, the diagnostic procedure is performing barium esophagogram that is showing a pathognomonic bird’s beak sign in the distal esophagus while upper gastrointestinal endoscopy is usually showing a narrow gastroesophageal junction. Esophageal manometry is MLN8237 inhibitor database the gold standard in diagnosing achalasia and high-resolution manometry with esophageal pressure topography that could increase the specificity and sensitivity . High-resolution manometry can divide achalasia into three subtypes . Type I MLN8237 inhibitor database is usually characterized by the loss of easy muscle contractility in the esophageal body and the lack of compartmentalized esophageal pressurization, whilst in type II achalasia, circular muscle excitation is enough as well as the longitudinal muscle tissue contraction is conserved, leading to intervals of compartmentalized esophageal compression or pressurization. Thus, it displays great treatment response by lower esophageal sphincter pressure decrease. The final and least regular achalasia type (type III) displays a spastic contraction from the distal esophagus that shows up in 20% of swallows . Treatment of achalasia consist of medical administration, pneumatic balloon dilatation, botulinum toxin shot, esophagectomy, and laparoscopic Heller’s myotomy. Pneumatic balloon dilatation pays to for type I and type II sufferers, whereas Heller’s myotomy with incomplete fundoplication works well for type II and III achalasia . Although balloon dilatation gets the same efficiency for the principal outcome, the low failure price of Heller’s myotomy helps it be the treating choice with a minimal operative risk for the patient. Recently, peroral endoscopic myotomy (POEM) has become the favored alternative treatment due to its minimally invasive technique . The short-term efficacy rates of POEM are similar to Heller’s myotomy and the response rate was over 90% . Furthermore, it also presented excellent symptom control over a 3-12 months period in all 3 types of achalasia, as previously reported in the cohort study [5, 6]. POEM was not only associated with a shorter duration of operation, hospital stay, and recovery time, but also with less blood loss, postoperative pain, and analgesic use. POEM was also found to be safe and effective in patients with persistent symptoms after Heller’s myotomy, although the rate of clinical success was lower in patients without prior Heller’s myotomy (81 vs. 94%, respectively) . We reported the case of an achalasia patient who received POEM after unsuccessful Heller’s myotomy. Case Report An 18-year-old Indian male was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained Mouse monoclonal to CD32.4AI3 reacts with an low affinity receptor for aggregated IgG (FcgRII), 40 kD. CD32 molecule is expressed on B cells, monocytes, granulocytes and platelets. This clone also cross-reacts with monocytes, granulocytes and subset of peripheral blood lymphocytes of non-human primates.The reactivity on leukocyte populations is similar to that Obs of occasional regurgitation and retrosternal pain. No weight loss was detected. Two years ago, laparoscopic Heller’s myotomy was carried out. On physical examination, the patient was not pale, no icterus and pedal edema were MLN8237 inhibitor database found. The thorax was normal, the stomach was soft, non-tender, and there were no ascites. The pre-procedure Eckardt score was 6. His routine blood investigations showed a normal hemogram. Liver and renal function test, serum electrolytes, blood glucose, and coagulation test were all normal. Thyroid-stimulating hormone, C-reactive protein, and erythrocyte sedimentation rate were normal. Hepatitis and acquired immunodeficiency syndrome (AIDS) viral markers were unfavorable. The X-ray showed bilateral lung parenchyma and cardiac examination appeared normal. Barium esophagography was performed 1, 2, and 5 min after ingestion answer showed a bird’s beak appearance with a dilated esophageal body (Fig. ?(Fig.1).1). Upper gastrointestinal endoscopy exhibited esophagus with liquid residue and resistance at the gastroesophageal junction suggestive of achalasia cardia. Esophageal manometry demonstrated the fact that basal lower esophageal sphincter pressure was regular.