Pull-back myotomy to prevent mucosal injury during peroral endoscopic myotomy for jackhammer esophagus

Mucosal injury is a notable perioperative complication of peroral endoscopic myotomy (POEM), occurring in 1.6%–25.8% of procedures [1] [2] [3]. Esophageal perforation caused by mucosal injury can lead to leakage of contents into the mediastinum, potentially resulting in mediastinitis [4]. Jackhammer esophagus is a hypercontractile esophageal motility disorder diagnosed using high-resolution manometry (HRM), necessitating extended myotomy in POEM [5]. Additionally, heightened caution is warranted when the length of the submucosal tunnel exceeds 13 cm, as it is associated with an elevated risk of mucosal injury [2]. Therefore, the POEM for jackhammer esophagus should be approached cautiously, considering the potential risk of mucosal injury.