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.

Figure 2 Eckardt scores. The Eckardt scores of patients were recorded before peroral endoscopic myotomy and at various times postoperatively; P < 0.01 vs before peroral endoscopic myotomy.

Figure 3 Esophageal high-resolution manometry. Representative manometric results from a patient with type II achalasia A: Before; and B: One month after peroral endoscopic myotomy. Lower esophageal sphincter pressure was reduced, with relaxation and passage of lower esophageal sphincter seen upon swallowing.

Figure 4 Barium swallow. A: Dilated esophagus showing a retained column of barium and “bird’s beak”, suggestive of achalasia; B: Esophagogram one month after peroral endoscopic myotomy. Barium passed and was excreted quickly through the lower esophageal sphincter.