Laparoscopic Heller myotomy and Dor fundoplication after failed POEM : case report and literature review

Background: Persistent achalasia-related symptoms after POEM(Per-Oral Endoscopic Myotomy) pose a therapeutic challenge. Methods: We reviewed the hospital charts of a patient presenting with persistent dysphagia, chest pain, and regurgitation after POEM. A review of the pertinent literature was also performed. Results: A 49-year-old man with a history of dysphagia for the previous 5 years was referred to our center after failure of POEM. He was diagnosed with type II achalasia and underwent POEM 2 months later in another hospital. Dysphagia, chest pain, and regurgitation persisted. The patient underwent four sessions of achalasia balloon dilatation without symptom resolution. Laparoscopic Heller myotomy and Dor fundoplication was successfully performed. At the 6‑month follow-up, the patient is symptom free. Conclusions: Incomplete distal myotomy or scarring may account for persistent symptoms after POEM. Laparoscopic Heller myotomy and Dor fundoplication is a safe and effective approach.