Peroral direct diverticulotomy: a salvage peroral endoscopic myotomy technique for patients with "blown-out myotomy".

ABSTRACT:

Background and aims

In patients with achalasia treated via Heller myotomy (HM) or peroral endoscopic myotomy (POEM), incomplete myotomy can lead to a "blown-out myotomy" (BOM) diverticulum, worsening obstruction, and dysphagia. We present peroral direct diverticulotomy (PODD), a salvage technique, similar to the "ultrashort tunnel" Zenker's peroral endoscopic myotomy technique, targeting the residual sphincter at the diverticular septum.

Methods

We performed PODD in a 49-year-old man with type I achalasia who underwent POEM with minimal relief (Eckardt score 4). At 18 months, the esophagram showed delayed emptying, incomplete myotomy, and BOM diverticulum, and endoscopy revealed a "puckered," tight lower esophageal sphincter (LES) and a BOM diverticulum. PODD achieved a 2-cm

SUBMITTER: Stavropoulos SN 

PROVIDER: S-EPMC12744740 | biostudies-literature | 2025 Dec

REPOSITORIES: biostudies-literature