Tips for performing a selective myotomy of the lower esophageal sphincter with hybrid knife during peroral endoscopic myotomy

Abstract Text We describe the technique for selective lower esophageal sphincter myotomy including gastric myotomy during POEM using the hydrosection system with the Hybrid Knife type T (HK-T).

• Perform injection (pressures<10 bar) into the connective tissue of the intermuscular plane to separate the inner circular layer from the longitudinal layer, creating sufficient space for the introduction of the HK-T.

• Perform myotomy under immersion in saline solution to enhance visualization and precision.

• Use the knife in “probe” mode (HK-T closed) to dissect the muscular/intermuscular plane in a sweeping motion (layer by layer). The sweeping motion in probe mode is particularly useful when carbonization or electrocoagulated tissue obstructs clear visualization of the muscular/intermuscular plane [1].

Video  http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/6a21ce98-6487-4bc9-8064-cde928b17c70/Uploads/16849_Tips_miotom%C3%ADa%20selectiva%20ESGE%20Days%202025%20comprimido.mp4

Publication History

Article published online:
27 March 2025

• References

• 1 Shiwaku H, Inoue H, Sato H. et al. Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan. Gastrointest Endosc 2020; 91 (05): 1037-1044.e2 Epub 2019 Nov 21. PMID: 31759035