A simple method to determine the proper length of the gastric myotomy during peroral endoscopic myotomy for achalasia

Peroral endoscopic myotomy (POEM) was first performed in 2008 by Inoue and since then has been used widely, with noninferiority to Heller’s myotomy [1]. A critical step during POEM is ensuring an appropriate length of the gastric myotomy (2–2.5 cm), as a short myotomy can lead to a lack of response, and if too long, a higher incidence of moderate reflux esophagitis may occur without improving clinical efficacy [2] [3].