Commentary

In this E-Video, Hallit et al. demonstrate the performance of peroral endoscopic myotomy (POEM), using an underwater technique, for the treatment of achalasia. As the majority of cohort studies show that the commonest adverse events observed following POEM are related to insufflation causing pneumothorax, pneumomediastinum, and pneumoperitoneum, the use of an underwater technique has the potential to mitigate these effects.

However, the fluid used for underwater technique should be able to conduct electrocautery and allow dissection. Moreover, further studies are necessary to confirm whether excessive fluid might give rise to mediastinal collection.

Publication History

Article published online:
17 December 2020