Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2322-2329
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2322
Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus: Two cases report
Youn I Choi, Kyoung Oh Kim, Dong Kyun Park, Jun-Won Chung, Yoon Jae Kim, Kwang An Kwon
Youn I Choi, Kyoung Oh Kim, Dong Kyun Park, Jun-Won Chung, Yoon Jae Kim, Kwang An Kwon, Department of Gastroenterology, Gil Medical Center, Gachon University, Incheon 21565, South Korea
Author contributions: Choi YI, and Kim KO contributed to study concept and design, acquisition analysis and interpretation of data, drafting of the manuscript. Park DK contributed to enroll patients and critically revised the manuscript. Chung JW, Kim KO, and Kwon KA contributed to enrolled the patients. All authors read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kyoung Oh Kim, MD, PhD, Associate Professor, Doctor, Professor, Division of Gastroenterology, Department of Internal Medicine, Gil Medical Center, Gachon University, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea. kkoimge@naver.com
Telephone: +82-32-4603778 Fax: +82-32-4603408
Received: January 19, 2019
Peer-review started: January 21, 2019
First decision: May 31, 2019
Revised: July 1, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 218 Days and 13.6 Hours
Abstract
BACKGROUND

Jack hammer esophagus is a relatively rare disease and to date, there is no dramatic treatment option. Recently, conventional per-oral endoscopic myotomy (POEM) have expanded their area into Jackhammer esophagus. However, several complications such as post procedure motility disorders (e.g., passage disturbance) are issues after POEM. To overcome these issues, we here introduced high-resolution manometry (HRM)-guided superficial partial circular muscle myotomy, which involves cutting only the superficial layer of the esophageal circular muscle.

CASE SUMMARY

We report two cases of patients with Jackhammer esophagus who were treated with HRM-guided extremely superficial partial circular muscle myotomy during POEM. Case 1 was a 53-year-old female with medication-refractory odynophagia and case 2 was a 47-year-old man who presented with chest pain. They were diagnosed with Jackhammer esophagus using HRM, and the hypercontractile segments of the esophagus were identified. HRM-guided extremely superficial partial circular muscle myotomy was performed while preserving the lower esophageal sphincter. Therefore, the circular and longitudinal muscle layers are preserved but hypercontractile movements are reduced, even after POEM. Patients’ clinical symptoms dramatically improved right after POEM, and 6-mo follow-up HRM revealed completely resolved status. During a 1-year follow-up period, patients were still in good health and remained symptom free.

CONCLUSION

HRM-guided superficial partial circular muscle myotomy may be a promising alternative to conventional POEM for treating Jackhammer esophagus with improved efficacy.

Keywords: Jackhammer esophagus; Hypercontractile; Partial circular muscle myotomy; Case report

Core tip: Jack hammer esophagus is a relatively rare disease and to date, there is no dramatic treatment option. Recently, conventional per-oral endoscopic myotomy (POEM) have expanded their area into Jackhammer esophagus. However, several complications such as post procedure motility disorders (e.g., passage disturbance) are issues after POEM. To overcome these issues, we here introduced high-resolution manometry-guided superficial partial circular muscle myotomy, which involves cutting only the superficial layer of the esophageal circular muscle for two patients.