For 10 years, Ms. Dan experienced recurrent dysphagia (difficulty swallowing), with each balloon dilation offering only temporary relief. In the past two months, her condition worsened, leading to a 5 kg weight loss and exhaustion. This prompted her to seek examination at Tam Anh General Hospital.

Esophageal-gastric X-ray revealed contrast medium retention in the esophagus, with no tumors or abnormal lesions detected. Endoscopy showed the cardia region had lost its ability to relax and open, accompanied by antral hyperemia. High-resolution esophageal manometry (HRM) confirmed the patient had type three achalasia.

Achalasia is categorized into three types based on esophageal manometry results: in type one, patients experience complete loss of esophageal peristalsis; type two is characterized by uniform increased pressure; and type three involves localized esophageal spasms with very strong and abnormal amplitudes.

Doctor Do Minh Hung, Director of the Center for Endoscopy and Gastrointestinal Endoscopic Surgery, stated that type three achalasia accounts for less than 10% of cases and is the most challenging to treat. Patients often experience severe chest pain and persistent dysphagia. Balloon dilation only affects the lower esophageal sphincter, whereas type three achalasia also causes rigidity in multiple segments of the esophageal body. Consequently, this method typically offers only short-term symptom improvement and carries a high risk of recurrence.

Doctor Minh Hung performs endoscopic esophageal sphincter myotomy on Ms. Dan. *Photo: Tam Anh General Hospital*

Following a consultation, the medical team decided to perform peroral endoscopic myotomy (POEM), a minimally invasive technique. This method allows doctors to directly access the constricted muscle layer from within the esophagus without the need for open surgery.

During the intervention, doctors noted a dilated esophagus due to prolonged food retention. The mucosa was injected and lifted, an entry point was made at the 6 o'clock position, and a submucosal tunnel was created extending to the esophagogastric junction. After clearly identifying the abnormal muscle fibers, the team incised approximately 8 cm of the circular muscle layer in the esophagus and an additional 2 cm into the stomach to completely release the constricted area. Finally, the mucosal opening was closed with endoscopic clips.

Ms. Dan recovered well, experienced minimal pain, and was discharged after one day. The patient consumed liquids for the first three days, then gradually transitioned to soft foods before resuming a normal diet. She was advised to avoid alcohol, carbonated drinks, and foods that easily irritate the esophagus.

Ms. Dan receives post-surgery care from a nurse. *Photo: Tam Anh General Hospital*

Patients with achalasia often present with progressively worsening dysphagia, a sensation of food sticking behind the sternum, chest pain, regurgitation of undigested food, weight loss, or persistent nocturnal cough due to reflux. Many cases are misdiagnosed as stomach disease or esophageal reflux, leading to delayed diagnosis. The exact cause of the disease is currently undetermined.

According to Doctor Hung, individuals experiencing persistent dysphagia, difficulty eating, or frequent post-meal chest pain should consult a gastroenterologist for accurate examination and diagnosis. Delayed treatment can lead to prolonged food retention, potentially causing esophagitis, aspiration, pneumonia, lung abscesses, or severe malnutrition.

Quyen Phan