Fig. 1 Illustrations and endoscopic views of the main procedural steps of gastric peroral endoscopic myotomy (G-POEM) showing: a submucosal injection and mucosal incision at the posterior part of the antrum, 4–5cm upstream from the pylorus; b tunneling by submucosal dissection using the Triangle-tip Knife (Olympus, Japan) up to the pyloric arch; c complete retrograde myotomy of the pylorus; d mucosal closure using through-the-scope endoclips.