Underwater peroral endoscopic myotomy (u-POEM) in a patient with severe chronic obstructive pulmonary disease

Abstract Text A 55-year-old man with severe chronic obstructive pulmonary disease (COPD) had a history of type 2 achalasia (eckardt score 10). Due to COPD, u-POEM was scheduled. We hypothesized that water rather than CO₂ might improve visualization and decrease complications (such as capnothorax and capnoperitoneum). A high definition gastroscope with a transparent cap mounted on the tip was used. A 2-cm mucosal incision was made with a triange tipknife and the endoscope was inserted into the submucosal space. CO₂ was switched off and water was infused. Underwater dissection was perfomed to create a tunnel extending 2cm below the gastroesophageal junction (GEJ). The underwater myotomy was started 8cm above the GEJ. At completion, a 10-cm posterior myotomy was perfomed [1] [2] [3].

Video  http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/7aa026d6-ace6-47c6-bbd6-3a1f287d8ab8/Uploads/16849_U-POEM_ESGE%20DAYS%202025%20FINAL.mp4

Publication History

Article published online:
27 March 2025

• References

• 1 Maida M. et al Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature Surg Endosc. 2021.
• 2 Sferrazza S. et al. Underwater Techniques in Gastrointestinal Endoscopy:Diving into the Depth Cancers (Basel). 2024.
• 3 Uschima Hugo et al.,u-POEM after tension capnoperitoneum and capnothorax during POEM...Endoscopy 2020