Initial experience and outcomes of peroral endoscopic myotomy for the treatment of oesophageal achalasia in a tertiary care centre

Oesophago-gastro-duodenoscopy was performed under general anaesthesia in the supine position using a high-resolution endoscope (GIF-H180J, Olympus) with carbon dioxide insufflation. Mucosotomy was carried out approximately 8-10 cm proximal to the gastro-oesophageal junction following a sub-mucosal “lift” in the 5-o’clock position. A submucosal tunnel was created down to the lesser curvature of the stomach using a combination of blunt dissection with an angled cap and electrocautery with a multifunctional probe (HybridKnife, Erbe). Coagulating forceps (Coagrasper; Olympus) were used on larger sub-mucosal vessels. The muscle layer and sling fibers of the lower esophageal sphincter were dissected using the multifunctional probe, from approximately 5 cm above the lower esophageal sphincter extending 2-3 cm into the gastric cardia. The smooth passage of the endoscope through the gastro-oesophageal junction was confirmed. The mucosal incision was closed with standard endoscopic haemoclips (Resolution, Boston Scientific). All procedures were performed by a single endoscopist (NN).