Open peroral endoscopic myotomy for achalasia with sigmoid-shaped esophagus.

A 54-year-old woman sought clinical consultation because of a > 27-year history of dysphagia. She had an Eckardt score of 13 and was diagnosed with sigmoid-type achalasia (S2 type, type II) based on esophageal motility testing, upper endoscopy, barium esophagography, and clinical presentations. We investigated a technique of peroral endoscopic myotomy (POEM) performed directly without a submucosal tunnel for the treatment of achalasia, which we call open POEM (O-POEM). O-POEM was successfully performed with no procedurerelated adverse events, resulting in a post O-POEM Eckardt score of 2 (▶Fig. 1, ▶Video1). The procedure time for O-POEM was 25.0 minutes and the length of the myotomy was 8.0 cm. Prophylactic antibiotics were given intravenously 30 minutes before O-POEM, and a nasogastric tube placement was continued for 2 days postoperatively. A E-Videos