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Technical and clinical (Eckardt score ≤ 3) success were 100% and 91%, respectively (follow-up 3-21 months). In 2 cases, the experienced endoscopist intervention was required (cases 2 and 3) because of difficult orientation at the esophagogastric junction. One mild pneumoperitoneum occurred, with no severe adverse events reported. Training in animal models and supervision by experienced endoscopist during first cases could provide the necessary skills to perform POEM safely and effectively. Training in animal models and supervision by e
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