{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:38:39Z","timestamp":1753879119835,"version":"3.41.2"},"reference-count":5,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,11,16]],"date-time":"2017-11-16T00:00:00Z","timestamp":1510790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2018,4]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM<\/jats:styled-content>) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM<\/jats:styled-content>) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM<\/jats:styled-content>. We aim to evaluate the feasibility and safety of REM<\/jats:styled-content> and usefulness of the navigation during REM<\/jats:styled-content>.<\/jats:p><\/jats:sec>Method<\/jats:title>A 42\u2010year\u2010old male with type III<\/jats:styled-content> achalasia who was treated with laparoscopic myotomy with fundoplication, multiple pneumatic balloon dilations, Botox injections and anterior POEM<\/jats:styled-content> of the middle and distal esophagus without symptomatic effect. Repeated high\u2010resolution\u2010 manometry (HRM<\/jats:styled-content>) revealed occluding contractions of high amplitude around and above the aortic arch. A probe\u2010based real\u2010time electromagnetic navigation platform was used to facilitate real\u2010time anatomical orientation and to evaluate myotomy position and length during REM<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>The navigation system aided in identifying the major structures of the mediastinum, and position and length of the myotomy. Twelve\u00a0weeks after REM<\/jats:styled-content>, the Eckardt score fell from seven at baseline seven to two. We also observed improvement with reduction of the pressure at the level of previous spasms in the proximal esophagus from 124\u00a0mmHg to 8\u00a0mmHg on HRM<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>REM<\/jats:styled-content> makes the proximal esophagus accessible for endoscopic myotomy. Potential indication for REM<\/jats:styled-content> is motility disorders in the proximal esophagus and therapy failure after POEM<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13252","type":"journal-article","created":{"date-parts":[[2017,11,16]],"date-time":"2017-11-16T11:16:41Z","timestamp":1510831001000},"source":"Crossref","is-referenced-by-count":1,"title":["Navigated retrograde endoscopic myotomy (REM<\/scp>) for the treatment of therapy\u2010resistant achalasia"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-1680","authenticated-orcid":false,"given":"K. D.","family":"Pham","sequence":"first","affiliation":[{"name":"Department of Medicine Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. F.","family":"Havre","sequence":"additional","affiliation":[{"name":"Department of Medicine Haukeland University Hospital Bergen Norway"},{"name":"National Centre for Ultrasound in Gastroenterology Haukeland University Hospital Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Lang\u00f8","sequence":"additional","affiliation":[{"name":"Department of Medical Technology SINTEF Technology and Society Trondheim Norway"},{"name":"Norwegian National Advisory Unit for Ultrasound and Image\u2010Guided Therapy St.\u00a0Olavs Hospital Trondheim Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. F.","family":"Hofstad","sequence":"additional","affiliation":[{"name":"Department of Medical Technology SINTEF Technology and Society Trondheim Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. A.","family":"Tangen","sequence":"additional","affiliation":[{"name":"Department of Medical Technology SINTEF Technology and Society Trondheim Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"M\u00e5rvik","sequence":"additional","affiliation":[{"name":"Norwegian National Advisory Unit on Advanced Laparoscopic Surgery St. Olav Hospital Trondheim Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O. H.","family":"Gilja","sequence":"additional","affiliation":[{"name":"Department of Medicine Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"National Centre for Ultrasound in Gastroenterology Haukeland University Hospital Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. G.","family":"Hatlebakk","sequence":"additional","affiliation":[{"name":"Department of Medicine Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Viste","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"Department of Surgery Haukeland University Hospital Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.12.027"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1391668"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1393095"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11548-015-1292-0"}],"container-title":["Neurogastroenterology & Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fnmo.13252","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.13252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T14:23:17Z","timestamp":1695565397000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.13252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,16]]},"references-count":5,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1111\/nmo.13252"],"URL":"https:\/\/doi.org\/10.1111\/nmo.13252","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"type":"print","value":"1350-1925"},{"type":"electronic","value":"1365-2982"}],"subject":[],"published":{"date-parts":[[2017,11,16]]},"article-number":"e13252"}}