Fig. 5. Steps of per-oral endoscopic myotomy with fundoplication. (A) Full-thickness myotomy done along the anterior wall of the submucosal tunnel. (B) Entry into peritoneal cavity. (C) The left lobe of liver and anterior side of stomach is seen. (D) Endoloop fixed with clips to anterior wall of stomach (distal anchor) (proximal anchor at distal end of myotomy site - not shown in picture). (E) By closing endoloop and approximating proximal and distal anchors fundoplication is completed. (F) Endoscopic view shows fundoplication wrap in funds of stomach.
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