Results: POEM was successfully performed and effectively released the dysphagia symptom in all patients. Both the patient symptom scores of achalasia, and the manometric pressure were significantly reduced after POEM. The median Eckardt score was 6.3 ± 1.9 and 0.8 ± 1.6 before and 6 months after POEM, respectively (P < 0.01). Manometric pressure studies (mean lower esophageal sphincter pressure) showed substantial improvement following POEM (preoperative 47.3 mmHg vs. postoperative 20.6 mmHg, P < 0.01). There was one case of intraoperative PKC412 solubility dmso complications: full-thickness esophagotomy, which was repaired endoscopically with no sequelae. Conclusion: POEM appears

to be a safe, effective and less invasive treatment against achalasia. However, further studies on technical method amendments and long-term follow-up examinations are still required. Key Word(s): 1. Esophageal; 2. Achalasia; 3. HRM; 4. POEM;

Presenting Author: UMITBILGE DOGAN Additional Authors: MUSTAFASALIH AKIN, SERKAN YALAKI, NEVINAKCAER OZTURK, AGAHBAHADIR OZTURK Corresponding Author: UMITBILGE DOGAN Affiliations: Objective: Superior mesenteric artery (SMA) syndrome is an unusual cause of proximal intestinal obstruction. The ZD1839 syndrome is characterized by compression of the third portion of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta and is primarily attributed to loss of the intervening mesenteric fat pad. We present the case of a 19-year old female who presented with epigastric pain, weight loss, and vomiting. Methods: A 19-year-old thin girl (BMI 13.8) presented with an 18-month history of severe

postprandial epigastric pain, nausea, anorexia, and weight loss. Upper gastrointestinal examination revealed a distended stomach and proximal duodenum to the level of the SMA. Upper endoscopy demonstrated a large, fluid-filled stomach. The duodenum was dilated down to the third part, at which point a tight, pulsating extrinsic stricture was noted. The endoscope could not be advanced past this narrowing. A CT scan of her abdomen confirmed a dilated stomach and proximal duodenum to the level of the SMA 上海皓元医药股份有限公司 in the absence of any external masses (Figure). The patient was successfully treated with open duodenojejunostomy. One month later, she remains asymptomatic with a total weight gain of 1.2 kg. Results: SMAS can be difficult to diagnose and diagnosis is often made on clinical suspicion and radiologic evidence of obstruction. Features of SMA syndrome on upper gastrointestinal series are a dilated proximal duodenum and vertical or oblique compression of the third portion of the duodenum. In our case, abdominal CT with intravenous contrast and upper gastrointestinal series were the only studies required for diagnosis. Although endoscopy is of minor positive diagnostic value, we feel it is mandatory in all patients to rule out intraluminal pathology.