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Barium esophagram before peroral endoscopic myotomy, with mild esophageal dilation, tertiary contractions, and poor transit of contrast through the esophagogastric junction, which had a bird beak appearance.
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Context 1
... of 100,000 per microliter and an international normalized ratio of 1.1. A CT scan was notable for paraesophageal varices and perigastric collaterals in the abdomen. A barium esophagram revealed mild esophageal dilation, tertiary contractions, and poor transit of contrast through the esophagogastric junction (EGJ), which had a bird beak appearance (Fig. 1). Endoluminal functional lumen imaging probe showed a reduced distensibility index of 0.9 mm 2 /mm Hg at the esophagogastric junction, a maximal esophagogastric junction diameter of 6.7 mm, spastic occlusive contractile response to distension suggestive of an outflow obstructive physiology across the esophagogastric junction, and a ...
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Citations
... 1,2 Compensated cirrhosis with portal hypertension has generally been considered a contraindication to POEM. 3 Despite this, previous case report series have reported successful POEM in patients with cirrhosis (both with and without esophageal varices). [4][5][6] We present a case of a patient with decompensated Child C cirrhosis and achalasia who underwent successful POEM without immediate complications. To our knowledge, this is the first case report to describe large-volume ascites that was managed peri-POEM with transjugular intrahepatic portosystemic shunt (TIPS) and temporary ascites drain placement. ...
Patients with both achalasia and decompensated cirrhosis can often present a therapeutic challenge because portal hypertension has generally been considered a contraindication to definitive therapies for achalasia. This case report depicts a patient who presented with progressive dysphagia, weight loss, and large-volume ascites; was diagnosed with type II achalasia and decompensated cirrhosis without esophageal varices; and underwent peroral endoscopic myotomy after preprocedural transjugular intrahepatic portosystemic shunt placement. Our case highlights the importance of multidisciplinary care and need for definitive therapies for these complex patients at high risk of malnutrition and sarcopenia.
