Delayed bleeding after peroral endoscopic myotomy for achalasia: conquered by clearing tunnel clots and identifying the bleeding site

作者：Jiayao Zheng, Shijie Yang, Wanyin Deng · 发表于：Endoscopy · 年份：2025 · DOI：10.1055/a-2688-6404 · 研究领域：Gastroesophageal reflux and treatments、Dysphagia Assessment and Management、Esophageal and GI Pathology

A 35-year-old man presented with dysphagia accompanied by regurgitation for 2 years, with his symptoms having worsened over the previous 3 months. After a series of comprehensive examinations, he was diagnosed with type 2 achalasia and underwent a successful peroral endoscopic myotomy (POEM). He developed chest pain 9 hours after the operation, which was accompanied by a small amount of hematemesis, and persisted without relief. An emergency gastroscopy indicated bleeding within the tunnel, so endoscopic hemostasis was performed with the patient under general anesthesia with tracheal intubation. During the gastroscopy, the tunnel was seen to be obviously swollen, and bleeding within the tunnel was therefore considered. The tunnel opening was re-established endoscopically, and a large number of dark red blood clots were observed ([ Fig. 1 ] a ). Removing the blood clots from the tunnel and finding the bleeding site were the key and most challenging aspects in achieving hemostasis. At first, a snare was tried to clear the blood clots; however, the tunnel filled with blood clots lacked sufficient space to open the snare. In contrast, with a clip, it was possible to more effectively grasp and remove the blood clots with fibrosis, thereby improving the efficiency of blood clot clearance. After spending 50 minutes clearing all the blood clots from the tunnel ([ Fig. 1 ] b ), we identified active oozing of blood from a blood vessel in the submucosa at the cardia ([ Fig. 1 ] c ). Hem...