Francisco Baldaque-Silva, MD from Centro Hospitalar de São João in Porto, Portugal presents this video case “New transillumination auxiliary technique for peroral endoscopic myotomy.”
In our experience, one of the most difficult steps of the peroral endoscopic myotomy (POEM) technique is the achievement of a proper tunnel length that will allow a safe and effective myotomy. If the myotomy is too short it may be ineffective; if it is too long it may be associated with increased risks such as bleeding and perforation. Several landmarks were previously described for localization of the cardia during POEM procedures. However, these landmarks may be difficult to identify and may not be accurate, which can result in inadequate length of the myotomy incision. We developed a new transillumination technique that, using conventional endoscopic devices, enables proper assessment of submucosal tunnel length and allows more accurate myotomy.
After creation of a submucosal tunnel along the distal esophagus and cardia, an ultrathin gastroscope is inserted through the nose into the gastric lumen. Once inside the stomach, the ultrathin gastroscope is oriented in a retroflex position with visualization of the cardia. Then, the light intensity of this gastroscope is decreased, enabling correct identification of the within-the-tunnel gastroscope through transillumination. This allows correct assessment of the submucosal tunnel and myotomy lengths. The transillumination POEM auxiliary technique was evaluated in 2 consecutive POEM procedures. It was feasible in both cases and led to extension of the tunnel and myotomy by approximately 2 cm in each patient.
There is an increased interest and widespread dissemination of POEM for the treatment of achalasia. As referred to in the article and exemplified in the video, this technique is safe and easy to perform. Using this technique, the POEM procedure becomes safer, more accurate, and reliable.
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