Evidence map›Paper›PMID 39026005›Full record

ArticleSurgical endoscopy2024

The effect of per-oral endoscopic myotomy by achalasia subtype as measured by impedance planimetry.

Matthew F Mikulski, Craig Ashcroft, Timothy J Morley, Christina Provenza, David J Desilets, John R Romanelli

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Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Achalasia management with per-oral endoscopic myotomy: A study of clinical success and complications at a tertiary center in Saudi Arabia.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Matthew F MikulskiDepartment of Surgery, Chan Medical School - Baystate Medical Center, University of Massachusetts, 759 Chestnut Street, Springfield, MA, 01199, USA. matthew.mikulski@baystatehealth.org.ORCID 0000-0002-1694-7894
Craig AshcroftDepartment of Surgery, Chan Medical School - Baystate Medical Center, University of Massachusetts, 759 Chestnut Street, Springfield, MA, 01199, USA.
Timothy J MorleyDepartment of Surgery, Saint Francis Hospital and Medical Center, Hartford, CT, USA.
Christina ProvenzaDepartment of Surgery, Chan Medical School - Baystate Medical Center, University of Massachusetts, 759 Chestnut Street, Springfield, MA, 01199, USA.
David J DesiletsDepartment of Gastroenterology, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA.
John R RomanelliDepartment of Surgery, Chan Medical School - Baystate Medical Center, University of Massachusetts, 759 Chestnut Street, Springfield, MA, 01199, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAchalasia is an esophageal motility disorder with three subtypes based on manometry that can treated with per-oral endoscopic myotomy (POEM). With the advent of impedance planimetry (EndoFLIP®), we hypothesized the three achalasia subtypes would have different pre-POEM EndoFLIP® diameter and distensibility index (DI) measurements but would be similar after POEM.

methodsA single-institution, retrospective review of consecutive POEM cases by a single surgeon-endoscopist team from 04/07/2017 to 08/28/2023. Patients with a diagnosis of achalasia were stratified into type 1, 2, or 3 based on pre-POEM manometry. Patient characteristics, Eckardt scores, and pre-and-post-POEM diameter and DI were compared by subtype with descriptive, univariate, and multivariable linear regression statistics.

resultsSixty-four patients met inclusion criteria, of whom 9(14.1%) had Type 1, 36(56.3%) had Type 2, and 19(29.7%) had Type 3. There were no differences between Types with respect to median pre-POEM Eckardt scores (9[IQR:7-9) vs. 8[IQR:6-9] vs. 7[IQR:5-8], p = 0.148), median post-POEM Eckardt scores (0[IQR:0-1] vs. 0[IQR:0-0] vs. 0[IQR0-0.5], p = 0.112). EndoFLIP® data revealed variation in median pre-POEM diameter and DI between Subtypes (6.9[IQR:6-8.5] vs. 5.5[IQR:5-6.8] vs. 5[IQR:5-6.1], p = 0.025 and 1.8[IQR:1.3-3.2] vs. 0.9[IQR:0.6-1.6] vs. 0.6[IQR:0.5-0.8], p = 0.003, respectively), but not in the change in diameter or DI post-POEM (5.1[IQR:4.3-5.9] vs. 5.1[IQR:4.1-7.1] vs. 5.9[IQR:5-6.4], p = 0.217 and 3.9[IQR:2.5-4.7] vs. 3.4[IQR:2.4-4.7] vs. 2.7[IQR:2.3-3.7], p = 0.461, respectively). However, after adjusting for potentially confounding factors, pre- or post-POEM diameter and DI did not demonstrate statistically significant differences among subtypes.

conclusionsAchalasia subtypes did not demonstrate different pre-POEM diameters or DI as measured by EndoFLIP® nor are there differences after POEM completion. While achalasia subtypes may have slightly different pathophysiology based on manometry findings, similar pre- and post-POEM impedance planimetry findings, along with similar Eckardt scores, support the use of POEM in the treatment of any achalasia subtype.

Indexed as

Electric ImpedanceEsophageal AchalasiaManometryNatural Orifice Endoscopic SurgeryAdultAgedEsophagoscopyFemaleHumansMaleMiddle AgedMyotomyRetrospective StudiesTreatment OutcomeAchalasia subtypeImpedance planimetryPer-oral endoscopic myotomy

Identifiers

PMID39026005

What OpenQuestion holds

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Registered trials

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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.