Laparoscopic long myotomy and Dor fundoplication guided by perioperative endoscopic ultrasound

An 80-year-old man with diffuse esophageal spasm underwent high-resolution manometry perioperatively and postoperatively. Integrated relaxation pressure was normal, and distal latency and peristaltic waves had disappeared. Endoscopic ultrasound (EUS) revealed esophageal muscle layer thickening to more than 1 cm in an area spanning the esophagogastric junction to the oral side. Laparoscopic long myotomy (LM) was performed followed by Dor fundoplication. The patient was discharged with a good postoperative course. Perioperative EUS-guided LM via the transhiatal approach was useful in this case.