IS TWO BETTER THAN ONE? ALTERNATIVE TECHNIQUES FOR G-POEM

Background The distance between muscular edges after standard G-POEM is short, potentially leading to sphincter reforming. We present two alternative techniques that may reduce this risk.

First case: double myotomy with muscular snare resection.

Two parallel pyloromyotomies were performed along the greater curvature. The residual muscular tissue between them was resected with a cold snare, resulting in a wide distancing of the muscular edges.

Second case: double tunnel myotomy.

Two pyloromyotomies were performed, one along the greater curvature and one along the lesser curvature. The resection of the pylorus at two different sections should reduce the risk of sphincter reforming.