ArticleAmerican journal of physiology. Gastrointestinal and liver physiology2022
Myotomy technique and esophageal contractility impact blown-out myotomy formation in achalasia: an in silico investigation.
Article in American journal of physiology. Gastrointestinal and liver physiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06883175 (Evolution of the Chicago Classification), which is not on this map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Evolution of the Chicago Classification: Bridging Physiology and Mechanics
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Prevalence and clinical characteristics of blown-out myotomy after E-POEM for achalasia: a systematic review and meta-analysis.Surgical endoscopy · 2026Pooled it
- Blown-out myotomy: emerging phenotype in post-myotomy failure after POEM and Heller myotomy.Esophagus : official journal of the Japan Esophageal Society · 2026Review
- Saudi Gastroenterology Association (SGA) clinical care pathway and standards of care for peroral endoscopic myotomy (POEM) in achalasia.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026Article
- Peroral direct diverticulotomy: a salvage peroral endoscopic myotomy technique for patients with "blown-out myotomy".VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2025Article
- Spastic Esophageal Disorders-How Much Muscle Should We Cut?Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2025Article
- Enhancing Chicago Classification diagnoses with functional lumen imaging probe-mechanics (FLIP-MECH).Neurogastroenterology and motility · 2024Article
- Automatic three-dimensional reconstruction of the oesophagus in achalasia patients undergoing POEM: an innovative approach for evaluating treatment outcomes.BMJ open gastroenterology · 2024Article
- Presence of esophageal contractility after achalasia treatment is associated with improved esophageal emptying.Neurogastroenterology and motility · 2024Article
- Tailored myotomy for the treatment of type 3 achalasia: Is there a role for the functional lumen imaging probe?Neurogastroenterology and motility · 2023Article
- Esophageal diverticula: from diagnosis to therapeutic management-narrative review.Journal of thoracic disease · 2023Review
- MRI-MECH: mechanics-informed MRI to estimate esophageal health.Frontiers in physiology · 2023Article
- Risk factors for clinical failure of peroral endoscopic myotomy in achalasia.Frontiers in medicine · 2022Review
- A mechanics-based perspective on the pressure-cross-sectional area loop within the esophageal body.Frontiers in physiology · 2022Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
Abstract
We used in silico models to investigate the impact of the dimensions of myotomy, contraction pattern, the tone of the esophagogastric junction (EGJ), and musculature at the myotomy site on esophageal wall stresses potentially leading to the formation of a blown-out myotomy (BOM). We performed three sets of simulations with an in silico esophagus model, wherein the myotomy-influenced region was modeled as an elliptical section devoid of muscle fibers. These sets investigated the effects of the dimensions of myotomy, differing esophageal contraction types, and differing esophagogastric junction (EGJ) tone and wall stiffness at the myotomy affected region on esophageal wall stresses potentially leading to BOM. Longer myotomy was found to be accompanied by a higher bolus volume accumulated at the myotomy site. With respect to esophageal contractions, deformation at the myotomy site was greatest with propagated peristalsis, followed by combined peristalsis and spasm, and pan-esophageal pressurization. Stronger EGJ tone with respect to the wall stiffness at the myotomy site was found to aid in increasing deformation at the myotomy site. In addition, we found that an esophagus with a shorter myotomy performed better at emptying the bolus than that with a longer myotomy. Shorter myotomies decrease the chance of BOM formation. Propagated peristalsis with EGJ outflow obstruction has the highest chance of BOM formation. We also found that abnormal residual EGJ tone may be a co-factor in the development of BOM, whereas remnant muscle fibers at myotomy site reduce the risk of BOM formation.
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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.