Combination of concurrent endoscopic submucosal dissection and modified peroral endoscopic myotomy for an achalasia patient with synchronous early esophageal neoplasms

Figure 3 Peroral endoscopic myotomy procedure. A: A 2-cm longitudinal incision was made into the mucosa after injection of natural saline with indigo carmine and epinephrine; B: A submucosal tunnel from the esophagus to the gastric cardia was created using a Dual knife; C: The submucosal tunnel was completed; D and E: The muscularis propria were dissected and the myotomy was completed using a Dual knife; F: The entry site in contralateral side of Endoscopic submucosal dissection wound was closed using hemostatic clips.