Underwater peroral endoscopic myotomy improves visualization and reduces adverse events in a high-risk patient with type III achalasia

Underwater peroral endoscopic myotomy improves visualization and reduces adverse events in a high-risk patient with type III achalasia Fig. 1 Underwater submucosal tunneling.a Mucosal incision on the posterior esophageal wall under continuous saline immersion.b Submucosal tunnel extended to the gastric side. Fig. 2 Underwater selective myotomy.a Initial dissection of the circular muscle fibers from 24 cm to 42 cm using the underwater technique.b Clear delineation of the submucosal and muscular layers facilitated by the saline environment.