Figure 2.

Peroral endoscopic myotomy in a patient with achalasia: (A) submucosal lifting injection with saline and indigo carmine, (B) submucosal tunneling with a triangular knife with integrated water jet (Triangle Tip Knife J, KD-645L, Olympus), (C) confirmation of gastric extension of submucosal tunnel by bluish discoloration of cardia, (D) selective circular myotomy in proximal tunnel, (E) completion of myotomy (note full-thickness myotomy toward the distal end of the tunnel), and (F) closure of the mucosal incision with clips.