Per-oral endoscopic myotomy: Major advance in achalasia treatment and in endoscopic surgery

Figure 5 Submucosal tunneling endoscopic resection technique. A: Gastroesophageal junction lesion seen on retroflexion during endoscopy; B: Endoscopic ultrasound probe demonstrates hypoechoic muscularis propria based lesion; C: Creation of submucosal tunnel parallel to esophageal lumen; D: Endoscopic submucosal dissection (ESD) with submucosal tunnel; E-F: Freeing of submucosal lesion via ESD; G: Removal of submucosal lesion from tunnel with biopsy forceps; H: 2.5 cm leiomyoma; I: Endoscopic sutured closure of mucosal entrance to tunnel.