title: Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy.
abstract: OBJECTIVE
  Peroral endoscopic myotomy (POEM) is technically challenging and time consuming. Repeated injection of dyed saline during tunneling is performed to enhance the demarcation between the submucosal layer and the muscularis propria. This process requires exchanging the knife for a catheter to spray dyed saline and is time consuming. This study aimed to describe a new method of injecting dyed saline through an integrated water jet channel during POEM.
  
  
  METHODS
  POEM was performed using a triangular tip knife. Repeated jet injection of saline mixed with indigo carmine was performed whenever the submucosal dissection plane became unclear.
  
  
  RESULTS
  The study cohort consisted of nine patients (8 achalasia, 1 Jackhammer esophagus). All procedures were technically feasible and successful without any complications and resulted in the patients' Eckhardt's scores returning to normal. The mean submucosal tunnel length was 13.3 cm and the mean myotomy length was 9.9 cm. The mean procedure time was 127 minutes.
  
  
  CONCLUSIONS
  The modified POEM technique with use of jet injection of dyed saline is simple and may render POEM easier and more efficient than the standard dissection method.
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Mouen A
authors: MA
authors: Khashab
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Ahmed A
authors: AA
authors: Messallam
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Payal
authors: P
authors: Saxena
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Vivek
authors: V
authors: Kumbhari
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Ernesto
authors: E
authors: Ricourt
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Gerard
authors: G
authors: Aguila
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Bani Chander
authors: BC
authors: Roland
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Ellen
authors: E
authors: Stein
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Monica
authors: M
authors: Nandwani
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Haruhiro
authors: H
authors: Inoue
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: John O
authors: JO
authors: Clarke
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004396:Coloring Agents / Q000008:administration & dosage; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007277:Injections, Jet; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009055:Mouth; D009061:Mouth Mucosa / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061214:Patient Safety; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D012965:Sodium Chloride