title: Intraoperative determination of the adequacy of myotomy length during peroral endoscopic myotomy (POEM): the double-endoscope transillumination for extent confirmation technique (DETECT).
abstract: OBJECTIVE
  Precise identification of the gastroesophageal junction (GEJ) is a challenging prerequisite for adequate length of an esophageal myotomy. Multiple standard methods to identify the GEJ have been described; however, a more objective modality is needed to ensure effective peroral endoscopic myotomy (POEM).
  
  
  METHODS
  In the double-endoscope transillumination for extent confirmation technique (DETECT), an ultraslim gastroscope is passed to the most distal aspect of the submucosal tunnel created during POEM. A regular gastroscope is advanced into the stomach, and the visualization of transillumination from the ultraslim gastroscope enables identification of the extent of the submucosal tunnel.
  
  
  RESULTS
  A total of 10 patients underwent POEM with DETECT. Initial submucosal tunneling was performed based on a determination of the GEJ location via standard methods. DETECT indicated the tunnel extent to be inadequate in 50% of patients, and the tunnel was extended a further 1 to 2cm. The mean initial tunnel length was 15.4cm, with a mean initial myotomy length of 11.9cm. DETECT was performed in less than 10 minutes without complications.
  
  
  CONCLUSIONS
  DETECT is an objective method for determining the adequacy of the submucosal tunnel length during POEM.
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: Vivek
authors: V
authors: Kumbhari
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Alba
authors: A
authors: Azola
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Mohamad El
authors: ME
authors: Zein
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: Ahmed
authors: A
authors: Abdelgelil
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Sepideh
authors: S
authors: Besharati
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Anthony N
authors: AN
authors: Kalloo
authors: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors: Payal
authors: P
authors: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D004195:Disease Models, Animal; D019723:Endoscopes; D004867:Equipment Design; D004931:Esophageal Achalasia / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014172:Transillumination / Q000379:methods*; D016896:Treatment Outcome