POEM procedure: Cross-sectional schematic of the distal esophagus and gastric cardia after submucosal tunnel formation and just before myotomy creation (IMAGE)
Caption
An endoscope with a transparent cap enters through a 2 cm mucosal incision into the submucosal “third” space, approximately 5 cm proximal to the lower esophageal sphincter. Four distinct tissue layers are shown from inside out: mucosa (intact except at the incision), submucosa (tunneled space), muscular layers (inner circular and outer longitudinal muscle fibers), and adventitia/serosa. This view demonstrates the precise surgical plane targeted for the subsequent myotomy. LES, lower esophageal sphincter; POEM, per-oral endoscopic myotomy.
Credit
John Wilkerson Keyloun
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License
CC BY-NC