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Video of the Month Modified Peroral Endoscopic Myotomy Bing-Rong Liu1, Ji-Tao Song1 and Mohammad Omar Jan1 Am J Gastroenterol 2015;110:499; doi:10.1038/ajg.2015.9

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Peroral endoscopic myotomy (POEM) has emerged as one approach to treating esophageal achalasia. Conventional POEM includes four main steps: (i) mucosal incision, (ii) tunnelization in the submucosal space, (iii) circular (or both circular and longitudinal) muscle dissection, and (iv) closure of the mucosal entry site. Tunnelization and the myotomy are the key procedures. Submucosal tunneling takes one-third to one-half of the total operation time. To improve the POEM procedure, we performed myotomy and tunneling in one step (first three panels) and then closed the entry site as before (last panel). We performed the modified procedure in two cases. The average procedure time was 24 minutes, and there was less bleeding as compared with conventional POEM. Conclusion: limiting the tunneling process to one step is more efficient than conventional POEM and causes minimal submucosal tissue injury. The procedure takes much less time than the conventional procedure. Additional studies are under way. 1

Harbin Medical University, Harbin, China.

To watch the Video of the Month, please visit AJG online: http://www.nature.com/ajg/journal/v110/n4/suppinfo/ajg20159s1.html

© 2015 by the American College of Gastroenterology

The American Journal of Gastroenterology

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Video of the month. Modified peroral endoscopic myotomy.

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