Fig. 3
From: Peroral Endoscopic Myotomy (POEM) for the treatment of achalasia in an Egyptian cohort
Peroral endoscopic myotomy (POEM) steps; a identification of the spastic cardia; b creation of submucosal bleb and tunnel entry 10 cm above the cardia; c creation of the tunnel with the mucosa at 12 o’clock and the muscle at 6 o’clock and submucosa in between; d coagulation of a blood vessel in the submucosa using a hybrid knife; e selective myotomy to the circular muscle using a hybrid knife; f full thickness myotomy (cutting both circular and longitudinal muscles) performed at the cardia; g closure of the tunnel opening with endoclips; and h widening of the cardia after POEM