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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.