Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study

Figure 1 Peroral endoscopic myotomy procedure. A: A 2 cm oblique incision was made into the mucosal surface; B: A long submucosal tunnel was created by careful electrocoagulation using an insulation-tipped electrosurgical knife; C: Endoscopic myotomy was initiated 2 cm distal to the mucosal entry using a hook knife. The inner circular muscle was dissected while the outer longitudinal muscle layer remained intact; D: After complete myotomy (approximately 10 cm), the mucosal entry site was closed using endoscopic clips.