Evidence map›Paper›PMID 42592676›Full record

ArticleClinical endoscopy2026

Anterior versus posterior peroral endoscopic myotomy: a prospective randomized controlled trial from a Thai tertiary center.

Tharathorn Suwatthanarak, Siwaree Maneesoi, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Somchai Leelakusolvong, Chainarong Phalanusitthepa

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Article in Clinical endoscopy, 2026. 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. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Tharathorn SuwatthanarakMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Siwaree ManeesoiMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chatbadin ThongchuamMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Thawatchai AkaraviputhMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Vitoon ChinswangwatanakulMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Somchai LeelakusolvongDivision of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chainarong PhalanusitthepaMinimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. chainarong.pha@mahidol.ac.th.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAchalasia is an esophageal motility disorder. Peroral endoscopic myotomy is widely used for all subtypes; however, randomized head-to-head evidence comparing the anterior and posterior approaches remains limited. We compared efficacy, safety, and reflux outcomes.

methodsWe conducted a single-center, single-blind, prospective randomized controlled trial from February 2023 to August 2024. Twenty-eight patients with achalasia types I-III were randomized to anterior or posterior peroral endoscopic myotomy. The primary outcomes were esophageal acid exposure at 3 months (24-hour pH monitoring) and clinical success (Eckardt score ≤3). The secondary outcomes were procedural parameters, complications, timed barium esophagography, manometry, and reflux esophagitis.

resultsBaseline characteristics were comparable between the groups. Procedural metrics and complication rates were similar and mild, with no severe adverse events. At 12 months, both groups showed significant symptom relief, reduced Eckardt scores, and decreased lower esophageal sphincter pressure. Posterior myotomy yielded a higher proportion of abnormal DeMeester scores (57.1% vs. 28.6%, p=0.14), although reflux esophagitis remained mild and comparable between the groups.

conclusionsPosterior peroral endoscopic myotomy demonstrated comparable efficacy, safety, and reflux outcomes. The anterior approach improved clearance on timed barium esophagography; however, both approaches achieved durable symptom control with acceptable safety profiles, supporting posterior myotomy as a valid alternative.

Indexed as

Esophageal achalasiaEsophageal sphincter, lowerEsophagitisManometryMyotomy

Identifiers

PMID42592676
PMCPMC13624762

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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.