Commentary

I read this E-Video article with considerable interest. As shown in the video, the authors used blunt dissection in creating the submucosal tunnel in a peroral endoscopic myotomy (POEM) procedure. Following mucosal incision and entry of the endoscope into the submucosal space and some initial electrodissection, blunt dissection using the tip of the distal attachment to the endoscope (the transparent cap) was then used effectively to establish the submucosal tunnel. Then when tunneling close to the lower esophageal sphincter, blunt dissection was combined with electrodissection to avoid injury to the mucosal flap. In general, blunt dissection can be easily accomplished in porcine models, but it is not always so easy in clinical cases. Actually, in this video blunt dissection was carried out in combination with knife cutting when hard submucosal tissue was encountered. Direct endoscopic visual control, as with any endoscopic procedure, is most important to achieve safe and effective submucosal tunneling in the appropriate layer.

Publication History

Article published online:
28 June 2022