Clin Endosc.  2025 Jan;58(1):149-152. 10.5946/ce.2024.011.

Modified submucosal tunneling by blunt dissection for peroral endoscopic myotomy

• Hashimoto Y
• Gomi K
• Ribeiro BDS

• KMID: 2564030
• DOI: http://doi.org/10.5946/ce.2024.011

Figure

• 

  Fig. 1. A tapered distal attachment for blunt submucosal dissection. A small-caliber-tip hood (outer diameter 11.0 mm, inner diameter 8.0 mm, DH-28GR; Fujifilm).

• 

  Fig. 2. (A) Longitudinal submucosal injection from the middle part of the esophagus to the gastroesophageal junction was performed using normal saline mixed with the EndoClot Polysaccharide Hemostatic System (EndoClot PHS; Olympus) and methylene blue. (B) An incision was started using a dual knife (DualKnife, KD-650U; Olympus) in the middle part of the esophagus.

• 

  Fig. 3. (A, B) Submucosal tunneling was performed using a blunt dissection technique with a small-caliber-tip hood. The submucosal tunneling extended to the cardia after blunt dissection.

Reference

1. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010; 42:265–271.

2. Sharata A, Kurian AA, Dunst CM, et al. Technique of per-oral endoscopic myotomy (POEM) of the esophagus (with video). Surg Endosc. 2014; 28:1333.

3. Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open. 2017; 5:E123–E129.

4. Hu X, Zhang YH, Liu XG, et al. Technically simplified peroral endoscopic myotomy: blunt dissection making submucosal tunneling fast and safe. Endoscopy. 2022; 54:724–725.

5. Kolb JM, Sowa P, Samarasena J, et al. Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus). VideoGIE. 2021; 7:82–84.

6. Marom G, Jacob H, Benson A, et al. The POEM bottom-up technique for achalasia. Surg Endosc. 2021; 35:6117–6122.

7. Familiari P, Borrelli de Andreis F, et al. Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority randomised controlled trial. Gut. 2023; 72:1442–1450.

8. Dai MS, Hu KW, Wu W, et al. EndoClot®SIS Polysaccharide injection as a submucosal fluid cushion for endoscopic mucosal therapies: results of ex vivo and in vivo studies. Dig Dis Sci. 2019; 64:2955–2964.