{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:38:34Z","timestamp":1790620714646,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T00:00:00Z","timestamp":1507766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>One of the challenges during peroral endoscopic myotomy (<jats:styled-content style=\"fixed-case\">POEM<\/jats:styled-content>) is ensuring the appropriate length of myotomy on the gastric side. To determine the appropriate distal end of the gastric myotomy, we focused on the two penetrating vessels (TPVs) found in the gastric cardia during <jats:styled-content style=\"fixed-case\">POEM<\/jats:styled-content>. In the present study, we evaluated whether the <jats:styled-content style=\"fixed-case\">TPVs<\/jats:styled-content> could serve as an accurate indicator of the appropriate distal end of the gastric myotomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients who underwent <jats:styled-content style=\"fixed-case\">POEM<\/jats:styled-content> between March and August 2016 were included for this study. When making the submucosal tunnel in the 5\u00a0o'clock direction into the stomach, two vessels penetrating through the circular muscle along the edge of oblique muscle in the cardia can be exposed. We designated these two vessels as <jats:styled-content style=\"fixed-case\">TPVs<\/jats:styled-content>. The myotomy was extended until the second <jats:styled-content style=\"fixed-case\">TPVs<\/jats:styled-content> was exposed. The anal end of the submucosal tunnel was confirmed by the double\u2010scope <jats:styled-content style=\"fixed-case\">POEM<\/jats:styled-content> technique, and the length from the gastroesophageal junction to the anal side end of the myotomy was measured by the scale on the endoscope.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 37 patients who underwent myotomy in the 5\u00a0o'clock position, <jats:styled-content style=\"fixed-case\">TPVs<\/jats:styled-content> were found in 34 patients (91.2%). Sufficient submucosal tunneling on the gastric side was confirmed by the double\u2010scope <jats:styled-content style=\"fixed-case\">POEM<\/jats:styled-content> technique in these 34 patients. Median length of the gastric myotomy was 3.0\u00a0cm (range 2\u20134\u00a0cm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">TPVs<\/jats:styled-content> appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.12957","type":"journal-article","created":{"date-parts":[[2017,8,28]],"date-time":"2017-08-28T16:48:42Z","timestamp":1503938922000},"page":"206-211","source":"Crossref","is-referenced-by-count":57,"title":["Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3714-8565","authenticated-orcid":false,"given":"Shinwa","family":"Tanaka","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiaki","family":"Kawara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Toyonaga","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Kobe University Hospital Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiro","family":"Inoue","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Showa University Koto\u2010Toyosu Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Bechara","sequence":"additional","affiliation":[{"name":"Gastrointestinal Diseases Research Unit Queens University Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namiko","family":"Hoshi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohumi","family":"Abe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiko","family":"Ohara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsukasa","family":"Ishida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Morita","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Umegaki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,12]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"30586","article-title":"Long\u2010term outcomes of per\u2010oral endoscopic myotomy in achalasia patients with a minimum follow\u2010up of 2\u00a0years: An international multicenter study","volume":"0016","author":"Ngamruengphong S","year":"2016","journal-title":"Gastrointest. 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