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<p>Achalasia, a primary esophageal motility disorder, can progress to an end-stage requiring interventions beyond standard therapies. The fluoroscopic findings of end-stage achalasia can be characterized by a dilated, redundant, sigmoidal esophagus with distal esophageal sump formation. Peroral Plication of the Esophagus (POPE) is a novel endoscopic procedure for patients with end-stage achalasia and prominent distal esophageal sump formation. Similar findings can also be seen in some patients after esophagectomy with gastric conduit reconstruction. POPE is indicated when esophageal redundancy rather than lower esophageal sphincter dysfunction is the primary concern. While initial studies show POPE’s technical feasibility, safety, and symptomatic improvement, to our knowledge there is no literature on the imaging findings and evaluation pre and post POPE. This pictorial essay aims to illustrate and describe the important components of a pre-POPE imaging evaluation, expected post-POPE anatomy, and short-term complications.</p>

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Peroral plication of the esophagus (POPE) for Achalasia – review of radiologic findings

  • 期刊论文

  • 发表日期：

    2025年9月27日

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  • Hayden Swartz,
  • Avinash Nehra,
  • Louis Wong Kee Song,
  • Ryan Alexander,
  • Karthik Ravi,
  • Kristina Flicek

摘要

Achalasia, a primary esophageal motility disorder, can progress to an end-stage requiring interventions beyond standard therapies. The fluoroscopic findings of end-stage achalasia can be characterized by a dilated, redundant, sigmoidal esophagus with distal esophageal sump formation. Peroral Plication of the Esophagus (POPE) is a novel endoscopic procedure for patients with end-stage achalasia and prominent distal esophageal sump formation. Similar findings can also be seen in some patients after esophagectomy with gastric conduit reconstruction. POPE is indicated when esophageal redundancy rather than lower esophageal sphincter dysfunction is the primary concern. While initial studies show POPE’s technical feasibility, safety, and symptomatic improvement, to our knowledge there is no literature on the imaging findings and evaluation pre and post POPE. This pictorial essay aims to illustrate and describe the important components of a pre-POPE imaging evaluation, expected post-POPE anatomy, and short-term complications.