Assessment of Different Modified POEM for Achalasia

"1. Initial mucosal incision. After submucosal injection, a reverse T entry incision is made at approximately 10 cm proximal to the gastroesophageal junction (GEJ).~2. Submucosal tunnel establishment. A submucosal tunnel is created to 2-3 cm distal to the GEJ.~3. Endoscopic myotomy. A selective circular muscle myotomy is carried out in a proximal to distal direction, from 2 cm distal to the mucosal entry down to 2 cm distal to the GEJ.~4. Zippered closure of mucosal entry. The mucosal incision is closed using hemostatic clips."

"1. Initial mucosal incision. After submucosal injection, a reverse T entry incision is made at approximately 6 cm proximal to the gastroesophageal junction (GEJ).~2. Submucosal tunnel establishment. A submucosal tunnel is created to 2-3 cm distal to the GEJ.~3. Endoscopic myotomy. A selective circular muscle myotomy is carried out in a proximal to distal direction, from 2 cm distal to the mucosal entry down to 2 cm distal to the GEJ.~4. Zippered closure of mucosal entry. The mucosal incision is closed using hemostatic clips."

"1. Initial mucosal incision. After submucosal injection, a reverse T entry incision is made at approximately 10 cm proximal to the gastroesophageal junction (GEJ).~2. Submucosal tunnel establishment. A submucosal tunnel is created to 2-3 cm distal to the GEJ.~3. Endoscopic myotomy. A selective circular muscle myotomy is carried out in a proximal to distal direction, from 2 cm distal to the mucosal entry down to 4 cm proximal to the GEJ, and a full-thickness muscle myotomy is continually carried out from 4cm proximal to the GEJ down to 2 cm distal to the GEJ.~4. Zippered closure of mucosal entry. The mucosal incision is closed using hemostatic clips."

"1. Initial mucosal incision. After submucosal injection, a reverse T entry incision is made at approximately 2 cm proximal to the spastic segment within the esophageal body, which is identified based on information gained from high-resolution manometry (HRM).~2. Submucosal tunnel establishment. A submucosal tunnel is created to 2-3 cm distal to the GEJ.~3. Endoscopic myotomy. A selective circular muscle myotomy is carried out in a proximal to distal direction, from 2 cm distal to the mucosal entry down to 2 cm distal to the GEJ.~4. Zippered closure of mucosal entry. The mucosal incision is closed using hemostatic clips."