ArticleNeurogastroenterology and motility2025
Endoscopic Prediction of Achalasia: Putting the CART Before the CARS.
Article in Neurogastroenterology and motility, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Diagnostic Performance and Reproducibility of the CARS Endoscopic Score in Achalasia: A Systematic Review and Meta-Analysis.Neurogastroenterology and motility · 2026Pooled it
- A combined endoscopy and functional lumen imaging probe panometry approach can expedite diagnosis of esophageal motility disorders.Gastrointestinal endoscopy · 2025Article
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Authors and funding
12 authors.
Funding
Abstract
BACKGROUND AND
aimsEndoscopy can detect features indicative of esophageal dysmotility, but standardized approaches for diagnosing achalasia based on these findings remain limited. Recently, the CARS score was developed to address this gap. This study aimed to evaluate the diagnostic utility of endoscopy in identifying achalasia, using the STARD framework and current reference standards.
methodsAdult patients with esophageal symptoms were prospectively enrolled from 2018 to 2023 and evaluated using endoscopy, esophageal manometry, FLIP panometry, and barium esophagram. The CARS score was assigned to endoscopic videos by two raters blinded to other clinical details. The diagnostic accuracy of the CARS score for predicting achalasia, based on Chicago Classification v4.0, was assessed through two interpretation methods: binary cutoffs for the total score and a classification tree model.
results316 patients were included: 115 patients with achalasia (36%), 113 with normal motility (36%), and 88 with other manometric findings (28%). A CARS score ≥ 4 demonstrated 72% sensitivity and 99% specificity for achalasia, while a score ≥ 3 had 83% sensitivity and 96% specificity. The optimal classification tree had three levels (resistance score at the top, followed by anatomy and content scores, with hernia presence at the bottom) and had a sensitivity of 90% and a specificity 92% for achalasia.
conclusionEndoscopy can accurately identify achalasia with high specificity using the CARS score. While motility testing to confirm an achalasia diagnosis remains essential prior to therapy, a high CARS score may help in the early identification of achalasia, especially in settings where motility testing is not readily available.
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