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By Percy Williams Bridgman

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Operation related factors: (1) The measures including 48 h of fasting before operation and cleaning of residual food on the operation day are very important for the prevention of postoperative infection. (2) Types of the tunnel entry: Currently, the types of entry incision mainly included transverse and longitudinal incision, which have no major impact on the healing of the incision. Transverse incision is more difficult to close than a longitudinal incision, so, completeness of sealing with endoscopic clips is closely related to the skills of the operator.

3a); crescent like structure is visible in the distal end of the esophagus adjacent to the cardia (Fig. 3b); below the crescent like structure is the ampullar structure (Fig. 3c), where vessels with branches and large roots are presented (Fig. 3d). Compared with muscle layer in mid-esophagus, the circular muscle is obviously thicker and the longitudinal muscle bundles turn slender. The mucosa, circular muscle and longitudinal muscle are adhered tightly together by dense fibrous tissue, which makes it difficult to divide apart for submucosal dissection or myotomy.

G) Partially sealed transverse incision. (h) Completely sealed transverse incision 4 22 g Techniques in Tunnel Establishment h Fig. 5 cm (Fig. 4c); (4) Advance the endoscope into the submucosa to continue the submucosal injection in the distal end of the incision (Fig. 4d), and then dissect the submucosal tissue along the two sides of the incision, so that the transparent-cap attached endoscope could enter the submucosal layer smoothly. Sealing of the transverse incision: Fix the first hemostatic clip to the middle point of the anal edge of the incision, and this clip will be called the “Anchor” clip (Fig.

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