ArticleSurgical endoscopy2026
Developing consensus in post-myotomy dysphagia: a Delphi study integrating anatomic and physiologic assessment from the ACTION group.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors.
Funding
Abstract
introductionRecurrent dysphagia after myotomy is multifactorial and challenging to classify. Although high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and contrast studies are widely used, no standardized framework integrates anatomic and physiologic findings in the post-myotomy setting. The Atlanta Consortium for Targeted Interventions in Oesophageal and Foregut Non-Malignant Disorders (ACTION) conducted a two-part study to evaluate inter-rater agreement among experts on mechanisms of recurrent dysphagia and develop early consensus using a modified Delphi process.
methodsIn Part 1, six achalasia experts independently reviewed 42 anonymized cases of recurrent post-myotomy dysphagia and assigned a primary failure mechanism from eight prespecified categories. Inter-rater agreement was measured using Fleiss' kappa. Physiologic measures including integrated relaxation pressure (IRP), distensibility index (DI), and maximum intra-bag FLIP pressure were compared across agreement tiers. Findings informed consensus statement development for Part 2, during which an expanded panel of 13 experts completed a two-round modified Delphi process. Round 1 involved rating 12 statements on a 5-point Likert scale. Consensus required a mean ≥ 4 with ≥ 80% agreement. Round 2 included structured discussion, revision, and re-rating of statements.
resultsAmong 42 cases (mean age 53.7 years; 57% female), the index intervention was Heller myotomy in 76%, POEM in 10%, and pneumatic dilation in 14% of cases. Diagnostic agreement was fair (Fleiss' κ = 0.25). Although high-agreement cases showed slightly lower median IRP and DI, distributions were broad and not statistically different, indicating that physiologic thresholds alone do not determine expert interpretation. After two rounds, the Delphi process resulted in 13 of 15 statements achieving consensus, emphasizing an anatomy-first framework with physiologic data interpreted in structural context.
conclusionSignificant variability exists in expert assessment of post-myotomy dysphagia. This study establishes early consensus on key failure mechanisms of myotomy failure and provides reproducible anatomic subtypes to support standardized diagnostic pathways.
Indexed as
Identifiers
What 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.