Underwater peroral endoscopic myotomy improves visualization and reduces adverse events in a high-risk patient with type III achalasia

Underwater peroral endoscopic myotomy (uPOEM), a variation of peroral endoscopic myotomy (POEM), eliminates gas insufflation, reducing complications such as pneumomediastinum and capnothorax, particularly in high-risk patients with comorbidities like chronic obstructive pulmonary disease (COPD). The underwater approach improves visualization of tissue planes, enhances the dissection process, and facilitates vessel cauterization, minimizing adverse effects.