Management of Peroral Endoscopic Myotomy Leak With an Esophageal Fully Covered Self-Expandable Metal Stents

Achalasia type II is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter. Peroral endoscopic myotomy (POEM) is a safe and minimally invasive procedure for achalasia. Although rare, complications such as esophageal perforation and pleural effusion can arise. This case study presents a 69-year-old woman with achalasia type II who developed esophageal perforation and empyema after POEM. Initial management with hemostatic clips was insufficient due to stent migration, necessitating a 135-mm fully covered self-expandable metal stent. Due to persistent leakage due to stent migration, a mega stent was ultimately placed, successfully sealing the esophageal leak. This report highlights the efficacy of mega stents as a viable option for managing recurrent esophageal leaks and complications post-POEM, especially in cases where stent migration complicates traditional approaches.