Management of recurrence after peroral endoscopic myotomy and submucosal tunneling endoscopic septum division

Achalasia sometimes coexists with esophageal diverticulum [1], and the combination of peroral endoscopic myotomy (POEM) and submucosal tunneling endoscopic septum division (STESD) is efficient and safe for relieving the symptom [2] [3]. However, the management of symptom recurrence after this combination of procedures is more challenging due to fibrosis of the submucosa. We present a case of short-term recurrence in a teenager after POEM and STESD, in which achalasia and epiphrenic diverticulum were treated through a repeat POEM procedure.