Peroral endoscopic myotomy in the treatment of a pregnant achalasia patient: A clinical case

Background. Achalasia is a rare disorder characterized by the loss of esophageal peristalsis and the failure of the lower esophageal sphincter to relax during swallowing.
Сase description. A 28-year-old female patient was urgently admitted to the Regional Clinical Hospital No. 2 (Ministry of Health of Krasnodar Krai) on February 29, 2024 at 28 weeks of pregnancy. Admitted in a serious condition, the patient presented with the following complaints: severe nausea, vomiting up to 10–15 times a day (which includes after eating liquid food), weakness, and dizziness for three weeks. Her medical history revealed recurring complaints since the age of 17; she had not been seen by a gastroenterologist. The patient attributed the latest symptoms to pregnancy. Based on her complaints, medical history, clinical picture, and examination data, the patient was preliminarily diagnosed with aspiration pneumonia and Type III esophageal achalasia. The patient was admitted to the intensive care unit. The opinion of the medical team, consisting of an obstetrician, a surgeon, a gastroenterologist, an intensivist, and a neonatologist is as follows: “aspiration pneumonia; Type III achalasia; 28 weeks pregnant; dysmetabolic Wernicke’s encephalopathy with a mild vestibular ataxia and oculomotor disorders; starvation ketosis in gestational diabetes mellitus in the context of a diet therapy; Grade 2 anemia; weight deficit (body mass index of 17.3 kg/cm2 ).” A blood transfusion was performed on March 2, 2024. Due to the severity of the patient’s condition, the presence of complications of the underlying disease, and the need to restore enteral nutrition, the medical team decided to surgically treat esophageal achalasia using peroral endoscopic myotomy. After the procedure, the patient received follow-up monitoring for three months at a maternity care center. During this period, the patient gained 5.5 kg. The baby was born full-term via natural birth, with an Apgar score of 8–9.
Conclusion. The use of peroral endoscopic myotomy in a pregnant patient is a rare case in global practice. The procedure was successful and had no effect on the further development of the fetus, enabling the patient to resume normal eating habits and ensuring the healthy development of the fetus.

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