ArticleDigestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society2026
An Exploratory Endoscopic Achalasia Phenotype With Visible Squamocolumnar Junction and Distal Esophagogastric Junction Relaxation Failure: Association With Gastroesophageal Reflux Disease After Peroral Endoscopic Myotomy (With Video).
Article in Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Unmasking the Distal Esophagogastric Junction-A Novel Endoscopic Esophago-Gastric Junction Phenotype and the Paradigm of Tailored Myotomy in Achalasia.Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2026Article
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10 authors.
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Abstract
BACKGROUNDS AND
aimsEsophageal achalasia is typically defined by impaired lower esophageal sphincter (LES) relaxation. In rare cases, complete circumferential visibility of the squamocolumnar junction (SCJ) and upper gastric folds (GFs) is seen endoscopically, suggesting functional obstruction may extend to the distal esophagogastric junction rather than being confined to the LES. Such cases appear to be associated with a high risk of gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM). We clarified the characteristics and significance of this rare endoscopic phenotype.
methodsWe retrospectively reviewed the data of 2553 patients who underwent POEM at our center between 2014 and 2023, and selected cases with full SCJ visibility and relaxation failure at the upper border of the GF before POEM. Patients with prior endoscopic or surgical treatments were excluded. Demographic, procedural, and GERD data were analyzed. GERD severity was assessed endoscopically.
resultsTwelve patients (0.7%) met these criteria. All were male, with a median age and body mass index of 48.5 years and 21.7 kg/m
conclusionsThese endoscopic findings may represent achalasia with distal relaxation failure and a high risk of conclusive GERD after POEM. Identifying this endoscopic feature is important for procedural planning.
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