title: Peroral endoscopic myotomy (POEM) for nutcracker esophagus. Three cases with 12 months follow-up.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) has been introduced as a new treatment of achalasia, and studies are emerging on POEM treatment of other esophageal motility disorders. The effects of medical treatment, botox injections and dilatations are often limited in patients with severe nutcracker esophagus (NE). We therefore decided to perform POEM in three patients with severe NE.
  
  
  METHODS
  Informed consent was provided. POEM was performed under general anesthesia on the distal esophagus and upper stomach. At 3 months, 6 months and 1 year postoperatively all patients had clinical follow-up, barium swallow and high-resolution manometry.
  
  
  RESULTS
  All patients displayed marked improvement with a significant reduction in Eckardt score at follow-up after 1 year, from 10, 10 and 11 to 3, 1 and 1, respectively. During follow-up, the patients were diagnosed with increased reflux index and one patient was diagnosed with gastroparesis.
  
  
  CONCLUSIONS
  Considering our results, treating severe NE with POEM has to be considered in the future; however, further studies have to confirm this.
authors.affiliation: Department of Surgical Gastroenterology L, Aarhus University Hospital , Nørrebrogade 44, DK-8000 Aarhus C , Denmark.
authors.forename: Helle Ø
authors.initials: HØ
authors.lastname: Kristensen
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Bjerregaard
authors.forename: Peter
authors.initials: P
authors.lastname: Rask
authors.forename: Frank Viborg
authors.initials: FV
authors.lastname: Mortensen
authors.forename: Rastislav
authors.initials: R
authors.lastname: Kunda
mesh_terms: D000328:Adult; D000368:Aged; D015154:Esophageal Motility Disorders / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013997:Time Factors
keywords: POEM; endoscopic myotomy; esophageal motility disorders; nutcracker esophagus