Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 10 Per-oral endoscopic myotomy procedure on 40-year-old female with type 1 achalasia, s/p pneumatic dilation 20-years prior, now with dysphagia and chest pain/spasms (Eckardt Score 8). A: Dilated esophageal body; B: Endoscopic functional lumen imaging probe (Endo-Flip) 2.0 showing distensibility of 1.5; C: Initial mucosal incision; D: Submucosal tunnel with coagulation of vessel using Hybrid i-knife; E: Circular myotomy using Hybrid i-knife; F and G: Full thickness myotomy with scissor-type stag beetle (SB) knife; H and I: Closure of mucosotomy using 5 endoscopic clips; J: Thin scope retroflex view of esophageal gastric junction showing light from standard gastroscope within the per-oral endoscopic myotomy tunnel.