A novel anatomically guided strategy for evaluation of sufficient myotomy during peroral endoscopic myotomy in patients with achalasia.

ABSTRACT: Peroral endoscopic myotomy (POEM) necessitates proper orientation of the anatomical landmarks throughout the whole procedure to assess the myotomy, which is the main target of POEM. Insufficient myotomy renders the procedure ineffective and may lead to nonresponse or recurrence, although longer myotomy may increase the risk of reflux. The current conventional methods for esophagogastric junction (EGJ) detection are often operator-dependent, time-consuming, and have questionable accuracy. We aimed to provide a novel anatomically based approach for more precise tailoring of myotomy. It depends on the clear demarcation of the meeting of 3 landmarks at the EGJ (the EGJ triad): esophageal adventitia, diaphragmatic crura and perigastric peritoneum. Once this triad is seen, after commencing the f

SUBMITTER: Madkour A 

PROVIDER: S-EPMC12366427 | biostudies-literature | 2025 Sep

REPOSITORIES: biostudies-literature