In vivo observation of aberrant innermost longitudinal muscle bundles during POEM

What is it about?

The esophageal anatomy consists of mucosa and a muscle layer, with a thick inner circular layer and a thin outer longitudinal layer, and adventitia. Peroral endoscopic myotomy (POEM) for achalasia permits in vivo identification of both muscle layers and selective circular myotomy, whereas the outer longitudinal muscle layer can remain as intact as possible, as a safety margin.

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Why is it important?

We report in vivo observation of aberrant innermost longitudinal muscle fibers in front of the circular muscle layer at the level of the lower esophagus and esophagogastric junction during POEM (Fig. 1; Video 1, available online at www.giejournal.org).