Peroral endoscopic myotomy for treatment of Guillain-Barre syndrome-associated achalasia: A rare case

Abstract

Guillain-Barre syndrome (GBS)-associated achalasia is a very rare disease of uncertain cause. We report the case of a patient diagnosed with GBS-associated type I achalasia who was successfully treated with peroral endoscopic myotomy (POEM). A 30-year-old man who was diagnosed with GBS 3 mo before was referred to our department with dysphagia and meal-related regurgitation. The results of esophagography, endoscopy, and high-resolution manometry (HRM) revealed type I achalasia. POEM that utilized a submucosal tunneling technique was performed to treat the GBS-associated type I achalasia. After POEM, smooth passage of a contrast agent into the stomach was shown in follow-up esophagography, and follow-up HRM revealed a decrease in the mean integrated relaxation pressure 22.9 mmHg to 9.6 mmHg. The patient remained without dysphagia for 7 mo, even though the patient’s neurological problems were not fully resolved. POEM may be a safe and effective treatment for GBS-associated type I achalasia.

Keywords: Peroral endoscopic myotomy; Achalasia; Guillain-Barre syndrome

Core tip: Guillain-Barre’ syndrome (GBS)-associated achalasia is a rare disease of uncertain cause. Previously, a case of GBS-associated achalasia that was treated with pneumatic dilation was reported. However, pneumatic dilatation has about a 25%-50% chance that the patient will require another procedure within five years. Here, we present a case of a patient diagnosed with GBS-associated type I achalasia who was successfully treated with peroral endoscopic myotomy.