II型贲门失弛缓症

                               
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POEM for type II achalasia (edited); this video uniquely shows active bleeding (3:50) during the dissection and its control. This type of bleeding is uncommon, but the highest risk is around the cardia. The video exhibits irrigation to pinpoint the bleeding source and effective use of hemostatic forceps (soft coagulation, effect 5, 80W). The severed artery branch exhibited spurting bleeding from both cut ends; the two points were sequentially treated with the forceps and dissection continued. It is important to be cognizant of coagulation during prophylactic and active hemostasis to minimize mucosal injury and to closely inspect the true lumen after hemostasis to detect mucosal injury as early as possible. In this case, the tunnel and true lumen were closely inspected after hemostasis and there was no inadvertent mucosotomy. The patient had no undue post procedural issues, complications, or need for transfusion and was discharged on POD1 as usual.