ArticleSurgical endoscopy2019
Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia.
Article in Surgical endoscopy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 24 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Impact of Peroral Endoscopic Myotomy and Other Treatments for Oesophageal Motility Disorders on Bolus Transport and Gastro-oesophageal Reflux. The pFlow Study
Comparison Study of Conventional Peroral Endoscopic Myotomy (POEM) and Different Modified Procedures of POEM for Achalasia
Outcomes of Short-length vs Standard-length Myotomy Using Per-Oral Endoscopic Myotomy (POEM) for Achalasia: A Randomized Controlled Pilot Study
Who cites it
24 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The efficacy of peroral endoscopic myotomy (POEM) for type III achalasia: a systematic review and meta-analysis.Surgical endoscopy · 2026Pooled it
- Standard length of peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2024Pooled it
- Clinical characteristics and manometric findings of esophageal achalasia-a systematic review regarding differences among three subtypes.Journal of smooth muscle research = Nihon Heikatsukin Gakkai kikanshi · 2023Pooled it
- Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis.Surgical endoscopy · 2020Pooled it
- Updated Systematic Review of Achalasia, with a Focus on POEM Therapy.Digestive diseases and sciences · 2020Pooled it
- Additional Diagnostic Yield of Ambulatory 24-h High Resolution Manometry With Impedance in Patients With Non-Cardiac Chest Pain or Non-Obstructive Dysphagia.Neurogastroenterology and motility · 2025Article
- Peroral endoscopic myotomy in spastic esophageal disorders: Clinical outcomes and optimal approaches.Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2025Article
- Laparoscopic Heller Myotomy for Symptomatic Epiphrenic Diverticula: A Modern Technique.Cureus · 2025Article
- The effect of per-oral endoscopic myotomy by achalasia subtype as measured by impedance planimetry.Surgical endoscopy · 2024Article
- Modified peroral endoscopic myotomy technique with retrograde on-demand myotomy for achalasia: a retrospective cohort study (with video).Surgical endoscopy · 2024Article
- Mini-review: Tailored per-oral endoscopic myotomy for type III achalasia.Neurogastroenterology and motility · 2023Review
- Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia.Neurogastroenterology and motility · 2023Article
- Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues-A Comprehensive Review.Life (Basel, Switzerland) · 2023Review
- Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia.Surgical endoscopy · 2023Article
- Training in esophageal peroral endoscopic myotomy (POEM) on an ex vivo porcine model: learning curve study and training strategy.Surgical endoscopy · 2023Article
- Esophagogastric junction compliance on impedance planimetry (EndoFLIP™) following peroral endoscopic myotomy (POEM) predicts improvement in postoperative eckardt score.Surgical endoscopy · 2023Article
- Type II achalasia with focal elevated pressures: A distinct manometric and clinical sub-group.Neurogastroenterology and motility · 2022Article
- Evolution and evidence-based adaptations in techniques for peroral endoscopic myotomy for achalasia.Gastrointestinal endoscopy · 2022Review
- Discordance between high-resolution manometry, esophagoscopy and contrast esophagogram in determining landmarks for per-oral endoscopic myotomy in spastic esophageal disorders: a word of caution.Surgical endoscopy · 2021Article
- Changes in the Treatment of Primary Esophageal Motility Disorders Imposed by the New Classification for Esophageal Motility Disorders on High Resolution Manometry (Chicago Classification 4.0).Advances in therapy · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionHigh-resolution esophageal manometry (HREM) is essential in characterizing achalasia subtype and the extent of affected segment to plan the myotomy starting point during per-oral endoscopic myotomy (POEM). However, evidence is lacking that efficacy is improved by tailoring myotomy to the length of the spastic segment on HREM. We sought to investigate whether utilizing HREM to dictate myotomy length in POEM impacts postoperative outcomes.
methodsComparative analysis of HREM-tailored to non-tailored patients from a prospectively collected database of all POEMs at our institution January 2011 through July 2017. A tailored myotomy is defined as extending at least the length of the diseased segment, as initially measured on HREM.
resultsForty patients were included (11 tailored versus 29 non-tailored). There were no differences in patient age (p = 0.6491) or BMI (p = 0.0677). Myotomy lengths were significantly longer for tailored compared to non-tailored overall (16.6 ± 2.2 versus 13.5 ± 1.8; p < 0.0001), and for only type III achalasia (15.9 ± 2.4 versus 12.7 ± 1.2; p = 0.0453), likely due to more proximal starting position in tailored cases (26.0 ± 2.2 versus 30.0 ± 2.7; p < 0.0001). Procedure success (Eckardt < 3) was equivalent across groups overall (p = 0.5558), as was postoperative Eckardt score (0.2 ± 0.4 versus 0.8 ± 2.3; p = 0.4004). Postoperative Eckardt score was significantly improved in the tailored group versus non-tailored for type III only (0.2 ± 0.4 versus 1.3 ± 1.5; p = 0.0435). A linear correlation was seen between increased length and greater improvement in Eckardt score in the non-tailored group (p = 0.0170).
conclusionsUsing HREM to inform surgeons of the proximal location of the diseased segment resulted in longer myotomies, spanning the entire affected segment in type III achalasia, and in lower postoperative Eckardt scores. Longer myotomy length is often more easily achieved with POEM than with Heller myotomy, which raises the question of whether POEM results in better outcomes for type III achalasia, as types I and II do not generally have measurable spastic segments.
Indexed as
Identifiers
30054739What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.