Blown-out myotomy as a cause of symptomatic recurrence after POEM: endoscopic management.

Blown-out myotomy (BOM) is an uncommon complication following surgical or endoscopic myotomy, associated with food retention and recurrent symptoms. We report a 58-year-old man with type III achalasia who developed dysphagia and regurgitation after peroral endoscopic myotomy (POEM). Endoscopy and imaging revealed a pseudodiverticulum at the previously treated site, consistent with BOM. The patient was successfully treated with an anterior myotomy, achieving complete and sustained symptom resolution. This case highlights the importance of considering BOM in patients with recurrent symptoms after myotomy and supports endoscopic management as a safe and effective option.