“You gotta lift to get ripped”: injection lift myotomy

Over the past several years, peroral endoscopic myotomy (POEM) has emerged as a first-line, minimally invasive therapy for achalasia [1]. In a traditional POEM procedure, injection is used to facilitate entry and dissection of a tunnel in the submucosal space [2]. Subsequently, a selective myotomy of the circular and variably longitudinal muscle fibers is performed with limited visualization of structures deep into the muscularis layer. Risks of the myotomy portion of POEM include injury to extraluminal structures and blood vessels, which can lead to pneumothorax, capnoperitoneum, and hemorrhage [3]. In this video, we present a novel technique that employs injection through the muscularis propria layer during the myotomy phase to facilitate a safer and more controlled myotomy ([Video 1]).