A double-scope method for creating a straight submucosal tunnel during peroral endoscopic myotomy

Abstract

Peroral endoscopic myotomy (POEM) is a revolutionary treatment for achalasia.1-3 It involves creating a submucosal tunnel directly to the stomach side; theoretically, a straight tunnel can be obtained by creating it perpendicular to the inner annulus muscle. Clinically, this is not always easy; therefore, we introduced a new method for controlling the submucosal tunnel direction in which a small-diameter endoscope is inserted along with the main endoscope. This allows us to check the illumination of the main scope in the submucosal layer, which can be particularly useful when treating a sigmoid-type anomaly with a highly flexed esophagus.

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