[Overview] Loss of cardia is a disease caused by esophageal-neuromuscular dysfunction, which is mainly characterized by high pressure of the lower esophageal sphincter (LES) and a reduced relaxation response to swallowing movements, so that food cannot enter the stomach smoothly. The clinical manifestations of cardia loss of relaxation include: dysphagia, retrosternal pain, and food reflux. [The goal of treatment is to lower the LES so that food can easily pass from the esophagus into the stomach. [Treatment] Currently, there are two types of treatment for cardia loss flaccidity, surgical and endoscopic. Surgical incision of the LES is certainly effective, but the surgery is traumatic, recovery is slow, hospital stay is long, and the cost of surgery is high. Endoscopic treatment methods include: endoscopic botulinum toxin injection, endoscopic dilation treatment. The disadvantages are that they cannot finally release LES obstruction, the efficacy is not certain, and the recurrence rate is high. [Background of technology development] Based on the above reasons, our department introduced the leading international technology, Peroral Endoscopic Myotomy (POEM). This technique is the leading one in Northeast Province. In 1980, POEM was reported, and the operation method at that time was to cut the cricoid muscle directly through the mucosal layer with a needle knife, but the method was poorly controlled for endoscopic operation, and it was easy to damage the surrounding tissues and cause perforation, so it was not popularly used, and based on the safety of the operation method, there were no relevant reports in the following 30 years. In 2007, Pasricha et al. successfully performed endoscopic dissection in a pig model. In recent years, with the development of new endoscopic resection techniques, the level and technique of endoscopic resection has been greatly improved. Inoue et al. were the first to report POEM in 17 patients with AC internationally, confirming its efficacy as an invasive treatment, which was well tolerated by patients and eliminated the pain of surgical procedures. [Preoperative preparation] The preoperative diagnosis is clear: barium meal imaging: lower esophagus “beak-like changes”, gastroscopy: cardia sphincter gas injection is not open, a large amount of esophageal fluid residue, the gastric flip mirror body can be seen “anti-tangle mirror body” phenomenon, if there is no contraindication to endoscopic treatment, it is possible to If there is no contraindication for endoscopic treatment, POEM treatment can be performed. [The procedure of endoscopic treatment starts with anesthesia: tracheal intubation, general anesthesia, and antibiotics. Then a myotomy of the esophageal mucosa is performed: a transparent cap is attached to the front of the gastroscope to aspirate trapped fluid and food residues from the lumen of the esophagus. A submucosal injection (a mixture of melanin, epinephrine, and glycerol fructose) was performed at a distance of approximately 8 cm-10 cm above the gastroesophageal junction (GEJ) in the right posterior wall of the esophagus. The mucosa was incised longitudinally about 2 cm with a Hook knife or TT knife to reveal the submucosa. The submucosal layer is separated and a submucosal “tunnel” is established: the cricoid muscle is incised longitudinally from above to 2 cm below the GEJ with a Hook knife, TT knife or Hybrid knife. all cricoid muscle bundles are cut from superficial to deep during the incision, preserving the longitudinal muscle bundles as much as possible and avoiding the clear cap to split the longitudinal muscle. For traumatic bleeding points electrocoagulation was performed at any time to stop the bleeding. After complete incision of the cricoid muscle, the submucosal “tunnel” and esophageal fluid were aspirated, the wound surface was flushed and the bleeding points and small vessels were electrocoagulated, the mirror was retracted to the mucosal incision, and a gastrointestinal decompression tube was placed under gastroscopic surveillance with multiple metal clips against the mucosal incision. [Postoperative management] The patient was fasted with water and rehydration on the postoperative day, proton pump inhibitor and antibiotics were applied intravenously, and the neck and chest were observed for subcutaneous emphysema. CT was checked on the first postoperative day to observe the presence of mediastinal and subcutaneous emphysema and the presence of pneumothorax, and if not, a liquid diet was allowed, and a semi-liquid diet was allowed on the second postoperative day. [Other related] The average hospitalization period is 5 days, and the average hospitalization cost is 15,000 yuan, which is significantly shorter than the surgical hospitalization period, and the cost is only 1/3 of that of the surgical operation. our department has applied this technology to treat pancreatic dystrophy so far, and the patients have no complications, and the treatment effect is very good, many patients who were dripping can now eat normally, and their weight has increased significantly, and the patients are very satisfied!