LAUSR

A 28-year-old man was referred to hospital with dysphagia, a symptom that had persisted for 10 years. He had recently been admitted to another clinic for aspiration pneumonia before being referred to our hospital. Gastroscopy showed a tightened esophagogastric junction (EGJ). We developed a fluoroscopy-guided peroral endoscopic myotomy (POEM) technique (▶Fig. 1, ▶Video1) using C-arm. This procedure was performed by an experienced gastroenterologist (J. Y. C), as follows. 1) A mucosal incision was made to create a submucosal tunnel entrance. 2) An indocyanine green (ICG) dye tracer was injected and an endoclip was placed below the EGJ. 3) Submucosal tunneling started 12cm proximal to the EGJ, and intraprocedural fluoroscopy was used to document the submucosal tunnel direction toward the EGJ. 5) The greenish submucosa previously labeled with ICG was visualized. 6) Myotomy was performed. 7) Mucosal entry was closed with endoclips. After the procedure, smooth passage of the endoscope was possible. There were no immediate complications, and the patient was discharged after 10 days. The procedure duration was 60 minutes, and the myotomy length was E-Videos