Gastroenterol. latinoam 2014; Vol 25, Nº 1: 17-23
Autores:
✉ Arturo Valle R, Mario Caracci L
POEM, new minimally invasive technique of endoscopic therapy for esophageal acalasia . Description of the technique based on a clinical case
The esophageal achalasia is an infrequent disease with significant morbidity. Multiple therapeutic alternatives are available with varying results. In 2008, POEM (Peroral Endoscopic Myotomy) endoscopic surgery was initiated in Japan (Inoue, Yokohama). Since then, it has been performed with excellent results. Objective: To describe this technique and the performance of POEM surgery based on a clinical case. Methods: The first POEM surgery was performed in Chile, according to the standards described in Inoue’s technique. It was performed by a single operator with previous training. Original devices were used. Prior informed consent was obtained, at Hospital Padre Hurtado in Santiago in January 2014. Results: A 34-year-old female patient, due to significant dysphagia and weight loss, was fully studied and diagnosed of esophageal achalasia type II. POEM surgery was carried out using the technique described by Inoue. The operating time was 150 minutes. No bleeding or intraoperative complications were detected. Upper endoscopic control at 24 h was normal, initiating progressive oral feeding. Discharged at the 4th postoperative day, without problems after a month. Conclusions: POEM surgery is a safe, effective and replicable treatment for esophageal achalasia in a public hospital in Chile.
La acalasia esofágica es una enfermedad infrecuente con morbilidad significativa. Existen múltiples alternativas terapéuticas con diferentes resultados. El año 2008 se inicia en Japón (Inoue, Yokohama) la cirugía endoscópica de POEM (Peroral Endoscopic Myotomy) con excelentes resultados. Objetivo: Describir la técnica y realización de la cirugía de POEM en base a un caso clínico. Métodos: Se planifico la realización de la primera cirugía de POEM en Chile, siguiendo los estándares descritos en su técnica. Fue realizada por un solo operador con entrenamiento previo, utilizando accesorios originales, previo consentimiento informado, en el Hospital Padre Hurtado de Santiago, en enero de 2014. Resultados: Se realizó en un paciente femenino de 34 años, previo estudio completo por disfagia y baja de peso significativa, diagnosticándose una acalasia esofágica tipo II. Se realizó una cirugía de POEM, siguiendo la técnica descrita por el Dr. Inoue. El tiempo quirúrgico fue de 150 min. No se presentó sangrado o complicaciones intraoperatorias. Endoscopia digestiva alta control a las 24 h fue normal, iniciando régimen progresivo. Alta al 4° día post operatorio, con favorable evolución al mes post operatorio. Conclusiones: La cirugía de POEM es segura, efectiva y reproducible para el tratamiento de la acalasia esofágica en un Hospital Público en Chile.