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Stephanie G. Worrell, MD, Evan T

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1 Peroral Endoscopic Myotomy for Achalasia in a Thoracic Surgical Practice 
Stephanie G. Worrell, MD, Evan T. Alicuben, MD, Joshua Boys, MD, Steven R. DeMeester, MD  The Annals of Thoracic Surgery  Volume 101, Issue 1, Pages (January 2016) DOI: /j.athoracsur Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 View of the dissecting endoscope in the distal extent of the submucosal tunnel using a retroflexed pediatric endoscope in the stomach. The 3-cm distance of the tunnel beyond the gastroesophageal junction is nicely verified. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 The change in Eckardt score based on the high-resolution manometric type of achalasia. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Esophageal emptying by timed barium swallow testing increased from a median of 36% at 5 minutes to 95% at 5 minutes after peroral endoscopic myotomy (p < ). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Upper endoscopy after peroral endoscopic myotomy (n = 22) showed esophagitis in 55% of patients. The esophagitis was LA grade A (n = 3) or B (n = 8) in most patients. The single patient with LA grade D esophagitis had a concomitant hiatal hernia. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 The integrated relaxation pressure before (pre) and after (post) peroral endoscopic myotomy (POEM) in 10 patients compared with the normal value [5]. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 High-definition three-dimensional manometry showing the lower esophageal sphincter before and after peroral endoscopic myotomy. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

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