PMC9887313_01
Upper gastrointestinal radiography showed diffusing contraction of the lower esophagus.
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F1
Upper gastrointestinal radiography demonstrated a diffuse contraction in the lower esophagus (Figure 1).
Upper gastrointestinal endoscopy and the technique of POEM in a case with acute pandysautonomia-associated distal esophageal spasm. (A) Endoscopic view before POEM revealing contractile ring at the lower esophagus. (B) Closed cardiac. (C) A longitudinal incision is made into the upper esophagus. (D) A submucosal tunnel from the esophagus to the gastric cardia is created. (E) Full-thickness myotomy of the lower esophagus. (F) Closure of the mucosal incision.
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F2
Endoscopic assessment before POEM revealed a contractile ring in the lower esophagus (Figure 2A). To relieve the patient's gastrointestinal symptoms since his family refused the treatment of plasmapheresis, POEM was performed under general anesthesia (Figure 2).
HREM showed a mean IRP of 9.0 mmHg, DCI of 125 mmHg   s   cm, DL of 4.2 s, and a CFV of more than 100 cm/s in test swallows with poor peristalsis in the esophageal body. DCI, distal contractile integral; DL, delayed latency; CFV, contractile frontal velocity.
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F3
Although HREM suggested a mean integrated relaxation pressure of 9.0 mmHg, a distal contractile integral of 125 mmHg s cm, delayed latency of 4.2 s, and contractile frontal velocity of >100 cm/s, it did not show evidence of simultaneous contraction (Figure 3).