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

Figure 11 Per-oral endoscopic myotomy procedure on 43-year-old female with type 2 achalasia for 25 years, s/p prior failed Heller Myotomy and Botox injection. A: Abundant submucosal vessels coagulated with stag beetle knife; B: Mucosal incision made in horizontal orientation facilitates closure with endoscopic suturing; C: Double layer suturing, starting with initial bite just left of incision, then middle and right; D: Second running suture from right to left for completion of double layer closure.