Enhanced Visualization of the Distal Myotomy Endpoint during Peroral Endoscopic Myotomy Using Indocyanine Green With...

Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia; however, accurately identifying the distal extent of myotomy remains a technical challenge. Indocyanine green with infrared imaging (ICG-IRI) may facilitate the intraoperative visualization of the esophagogastric junction.

We evaluated 39 patients who underwent POEM using ICG-IRI. The primary outcome was the success rate of ICG-IRI, defined as a clear endoscopic visualization of fluorescence at the distal myotomy endpoint. The secondary outcomes included technical success, changes in integrated relaxation pressure, and Eckardt scores before and after treatment.

The technical success rate was 100%, and ICG-IRI was successful in 94.9% of the cases (37/39). The median integrated relaxation pressure decreased from 26.9 to 10.8 mmHg, and the median Eckardt score improved from 5.0 to 1.0 (both p < 0.01). No adverse events were attributed to the ICG-IRI.

The ICG-IRI method is a reliable visual aid for identifying distal myotomy endpoints during POEM. This technique may enhance the procedural accuracy and improve clinical outcomes.