A Novel Overtube-assisted Endoscopic Technique for Esophageal Clearance before Performing the POEM Procedure

Methodssnare use-our method is simple, widely applicable, and requires no learning curve or specialized accessories.Complete clearance can be achieved within minutes, enabling safe and effective Adequate clearance of the esophagus and stomach before peroral endoscopic myotomy (POEM) is crucial to reduce the risk of aspiration and to enhance procedural safety.We describe a novel overtube-assisted technique using a therapeutic endoscope and a standard endoscopic snare to remove retained food debris and large boluses from the esophagus and stomach.The overtube provides effective airway protection, allows repeated intubation, and facilitates efficient retrieval of bulky residues.This technique employs a Guardus overtube (outer diameter 9.8-11.7 mm), a therapeutic Olympus endoscope (GIF-H1190F), and conventional endoscopic snares (standard oval-shaped snare of size 15 mm).The overtube is positioned under endoscopic guidance, and the wide working channel of the therapeutic endoscope (2.8 mm) permits easy passage of the snare, enabling rapid and safe removal of large food chunks (Figs 1A to D and Supplementary Video S1).