Achalasia cardia

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[size=20px]An eleven year old girl presents with difficulty swallowing. An esophagram shows a distended esophagus and “beaking” at the gastroesophageal junction. Upper endoscopy demonstrates dilated esophageal body and puckering at the LES and retained saliva in the esophagus. The treating gastroenterologist performed esophageal pressure topography and noted the integrated relaxation pressure is elevated at 20mmHg and the esophagus has no peristalsis. According to the Chicago Classification of Esophageal Motility, this patient has a Type I achalasia b Type II achalasia c Type III achalasia d Diffuse esophageal spasm[/size]

[center]Laparoscopic Heller myotomy for achalasia See video in 2nd post[/center]

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A 17 year old boy is seen in the pediatric surgery clinic after ongoing issues with dysphagia. Subsequent evaluation reveals a diagnosis of achalasia. Per-oral endoscopic myotomy (POEM) has been used in the adult population to manage this disease process. A contraindication to the POEM procedure is? A Type I Achalasia B Type II Achalasia C Type III Achalasia D Pseudoachalasia E Nutcracker esophagus​

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[size=20px]A 14-year old boy presents with progressive dysphagia and is found to have achalasia on manometric and contrast studies. The family wants to pursue endoscopic therapy for his achalasia and wishes to discuss the best option for long term relief. You recommend A balloon dilation. B botulinum toxin injection. C bougie dilation. D radiofrequency ablation. E submucosal myotomy.[/size]

[size=20px]A 15-year old boy returns to the clinic two years following a laparoscopic Heller myotomy with Dor fundoplication for achalasia. Though he had early excellent resolution of his symptoms he now has dysphagia and recent weight loss. An esophagram suggests recurrence of the distal narrowing with moderate obstruction and manometry confirms recurrent achalasia. The procedure most associated with long term success in this patient with recurrent achalasia is A revision Heller myotomy. B esophagoscopy and botulinum toxin injection. C esophagectomy with gastric replacement. D pneumatic balloon dilation. E peroral endoscopic myotomy (POEM).[/size]

A thirteen-year old girl has progressive difficulty swallowing. An esophagram and manometry are suggestive of achalasia. [center][/center] [size=20px]The most definitive management of achalasia is A oral nitrates. B pneumatic dilation. C botulinum toxin injection. D thoracoscopic myotomy. E laparoscopic esophagocardiomyotomy.[/size]

First one with correct answer with justification win. [size=20px]A fifteen-year old female with dysphagia related to achalasia is referred for a laparoscopic esophagocardiomyotomy. She had previously undergone two pneumatic esophageal dilations and a Botulinum toxin injection resulting in only temporary relief. After the completion of the laparoscopic myotomy a small hole in the mucosa is identified. The most appropriate management is A tube thoracostomy drainage. B repair mucosa only. C repair the mucosa and muscle with referral for additional medical therapy. D repair the mucosa and reinforce with a partial fundoplication. E place an esophageal sten…