Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease

Figure 1 Case illustration of peroral endoscopic circular myotomy. A: Endoscopy showing dilated esophagus; B: Longitudinal mucosal incision was made to create a tunnel entry; C: Submucosal tunnel; D: Endoscopic image of the circular muscle; E. Circular myotomy; F: Tunnel entry was closed with several clips.

Figure 2 Case illustration of peroral endoscopic full-thickness myotomy. A: Endoscopy showing dilated esophagus; B: Longitudinal mucosal incision was made to create a tunnel entry; C: Submucosal tunnel; D: Circular myotomy was initially performed; E: Full-thickness myotomy was performed; F: Tunnel entry was closed with several clips.

Figure 3 Patient selection and enrollment. POEM: Peroral endoscopic myotomy; GERD: Gastroesophageal reflux disease.

Figure 4 Endoscopic images of esophagitis after peroral endoscopic myotomy. A: Los Angeles Grade A esophagitis; B: Los Angeles Grade B esophagitis.