Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

Figure 1 Closure of the mucosal penetration using fibrin sealant. A: Spraying fibrin sealant in the submucosal tunnel; B: Fibrin sealant fully covers the penetration (imaging from esophageal lumen); C: Fibrin sealant fully covers the penetration (imaging from stomach lumen).

Figure 2 Closure of a 0. 8 cm × 0.4 cm mucosal penetration using a hemostatic clip and fibrin sealant. A: The appearance of the 0.8 cm × 0.4 cm mucosal penetration (imaging from the submucosal tunnel); B: A hemostatic clip was used to make a preliminary clipping (imaging from esophageal lumen); C: Fibrin sealant fully covers the preliminary clipped penetration (imaging from stomach lumen).

Figure 3 Two kinds of mucosal penetration under esophagogastroduodenoscopy. A: Hole-like penetration (imaging from submucosal tunnel); B: Hole-like penetration (imaging from esophageal lumen); C: Linear penetration (imaging from esophageal lumen).

Figure 4 Healing process of the mucosal penetration after being closed using fibrin sealant. A: The appearance of penetration at one week after peroral endoscopic myotomy (POEM) (imaging from esophageal lumen); B: The appearance of penetration at six weeks after POEM (imaging from esophageal lumen).