Same site submucosal tunneling for a repeat per oral endoscopic myotomy: A safe and feasible option

Figure 1 Endoscopic pictures from the first per oral endoscopic myotomy attempt showing: Gastroesophageal junction (A), cardia before myotomy (B), mucosotomy site (C), initial dissection site (D), creating the submucosal tunnel (E), and closure of mucosotomy (F).

Figure 2 Gastrografin swallow study obtained after the index per oral endoscopic myotomy attempt showing a grossly distended esophagus consistent with achalasia, and postoperative edema with slow emptying at the gastroesophageal junction. No evidence of contrast leakage is seen.

Figure 3 Endoscopic pictures taken from the repeat per oral endoscopic myotomy showing: sigmoid esophagus (A), cardia before myotomy (B), mucosa of previous dissection site (C), Mucosal bleb (D), submucosal tunneling (E), initial myotomy (F), completed myotomy (G), cardia after submucosal tunnneling (H), closure of mucosotomy (I).

Figure 4 Comparison of submucosal tunnel of the index (A) and repeat (B) per oral endoscopic myotomy.