case_images: PMC11827286_01
case_images: HRM image of case 1.. HRM: high-resolution manometry, UES: upper esophageal sphincter, TZ: transition zone, LES: lower esophageal sphincter, PIP: pressure inversion point.
case_images: cureus-0017-00000077467-i01.jpg
case_images: PMC11827286_01_cureus-0017-00000077467-i01.jpg
case_images: FIG1
case_images: Esophageal high-resolution manometry (HRM) examination showed a median integrated relaxation pressure (IRP) of 12.6 mmHg with all failed swallows (Figure 1).
case_images: POEM procedure of case 1.. (A) pre-POEM esophagogastric junction; (B) submucosal injection; (C) submucosal dissection; (D) myotomy; (E) mucosal defect closure; and (F) post-POEM esophagogastric junction. POEM: peroral endoscopic myotomy.
case_images: cureus-0017-00000077467-i02.jpg
case_images: PMC11827286_01_cureus-0017-00000077467-i02.jpg
case_images: FIG2
case_images: The mucosal incision was closed with the help of hemoclips (Figure 2).
case_images: PMC11827286_02
case_images: POEM procedure for case 2.. (A) pre-POEM esophagogastric junction; (B) submucosal injection; (C) submucosal dissection; (D) myotomy; (E) mucosal defect closure; (F) post-POEM esophagogastric junction. POEM: peroral endoscopic myotomy.
case_images: cureus-0017-00000077467-i03.jpg
case_images: PMC11827286_02_cureus-0017-00000077467-i03.jpg
case_images: FIG3
case_images: POEM was done following the steps outlined for case 1, and the patient was discharged the next day after his gastrografin swallow, which demonstrated no leakage (Figure 3).