Figure 1: POEM procedures. (a) Creation of submucosal tunnel. A submucosal tunnel was created from the mucosal incision point (12 cm above the GEJ) to 3 cm below the GEJ. The palisade vessels on the right half of the picture confirmed the tip of the cap-fitted endoscopy had reached GEJ. The underlying inner circular muscle can also be viewed. (b) Endoscopic myotomy. The inner circular muscle was transected while remaining the outer longitudinal muscle layer intact. (c) Completion of the endoscopic myotomy. The length of myotomy was 13 cm (10 cm above the GEJ to 3 cm blow the GEJ). (d) Closure of the mucosal entry point by clips.