Conventional endoscopic images of the EGJ and mid-thoracic esophagus before and after POEM. 3-a, b Before POEM, the EGJ is extremely tight. Whitish color change is seen on the surface mucosa without permeability of vascular structures. 3-c, d After POEM, the narrow segment of the EGJ has been totally released. The status of the surface mucosa is significantly improved, and permeability of the surface vascular patterns is restored.