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 | Fig. 1.Upper gastrointestinal series shows a definite delayed barium passage at the pyloric ring (A, B). After gastric peroral endoscopic pyloromyotomy (G-POEM), improved barium passage at the pyloric ring was noted (C, D). |
 | Fig. 2.Electrogastrophy (EGG) shows high amplitude and excessively regular 3-cycles-per-minute patterns (red circle), which are the representative findings of gastric outlet obstruction on EGG. |
 | Fig. 3.Initial computed tomography (CT) scan showed a diffusely dilated stomach and proximal small bowel (A). Follow-up CT scan showed an improved state of dilated stomach (B). |
 | Fig. 4.The endolumenal functional lumen imaging probe (EndoFLIP) showed moderately thickened pyloric muscles, of up to 0.8 mm2/mmHg of decreased distensibility along the pylorus (A). After gastric peroral endoscopic pyloromyotomy (G-POEM), EndoFLIP showed improved distensibility along the pylorus, of up to 5.9 mm2/mmHg (B). |
 | Fig. 5.Gastric peroral endoscopic pyloromyotomy (G-POEM) of the pyloric ring. Very tight pyloric ring was noted before G-POEM (A). Submucosal injection and muscle myotomy along the prepyloric antrum and pylorus (thin red arrows) until duodenal bulb (thick red arrow) were performed (B). Frozen biopsy (thin red arrow and dotted lines) was performed during G-POEM (C). After procedure, about 6 cm sized muscular myotomy was done (D). It was closed with hemoclipping (E). After G-POEM, a relatively widely open pyloric ring was noted (F). |
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