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Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEMprocedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique thatis divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtypeachalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM methodcan also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change oftreatment failure.
