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

Figure 26 Gastric per-oral endoscopic pyloromyotomy in a patient with severe gastroparesis. A: Markings made for mucosal incision on the antrum greater curve, 4-5 cm proximal to the pylorus; B: Submucosal injection; C: Initial mucosal incision; D: Submucosal tunnel extended with i-knife until pylorus muscle is identified; E: The hook knife is then used to carefully cut the pylorus muscle; F: Myotomy of the pylorus; G: The myotomy is extended proximally for approximately 2 cm along the antrum; H: Closure of the mucosotomy is accomplished with Overstitch suturing device; I: Upper gastrointestinal contrast X-ray study shows no leak, with free flow of contrast through the pylorus.