{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:08:12Z","timestamp":1784228892634,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>During peroral endoscopic myotomy (POEM) for achalasia, endoscopic esophagogastric junction (EGJ) opening is generally considered a sign of successful myotomy. However, in clinical practice, the EGJ may appear to open immediately after submucosal tunneling, even before myotomy is performed. We defined this phenomenon as pseudo\u2010dilation and evaluated changes in EGJ appearance during POEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 65 consecutive patients who underwent POEM between February and June 2025. Endoscopic images obtained at three stages\u2014before POEM, after submucosal tunneling, and after myotomy\u2014were evaluated using a three\u2010tier Endoscopic Junctional Dilation (EJD) grade. Differences in EJD grade across procedural stages were analyzed using the Friedman test, with post hoc Wilcoxon signed\u2010rank tests and Bonferroni correction. The Bickenb\u00f6ller statistic was used as a complementary analysis. Two certified endoscopists independently evaluated all images, and interobserver agreement was assessed using Cohen's \u03ba and weighted \u03ba.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The EJD grade increased significantly after submucosal tunneling compared with before POEM (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). A significant difference was observed between the post\u2010tunneling and post\u2010myotomy stages (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002); however, most patients showed no change in EJD grade, and the overall distribution of grades remained unchanged (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.124). Overall, pseudo\u2010dilation occurred in 95.4% of patients. Interobserver agreement in EJD grade assessment was substantial to perfect across all procedural stages (\u03ba = 0.889; weighted \u03ba = 0.940).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pseudo\u2010dilation of the EGJ was commonly observed immediately after submucosal tunneling during POEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/deo2.70360","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T04:21:15Z","timestamp":1780287675000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Pseudo\u2010dilation of Esophagogastric Junction During Peroral Endoscopic Myotomy: (With Video)"],"prefix":"10.1002","volume":"7","author":[{"given":"Kei","family":"Ushikubo","sequence":"first","affiliation":[{"name":"Digestive Disease Center Showa Medical University Koto Toyosu Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiro","family":"Inoue","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Showa Medical University Koto Toyosu Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippei","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Showa Medical University Koto Toyosu Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikko","family":"Raymundo","sequence":"additional","affiliation":[{"name":"Digestive Disease Center Showa Medical University Koto Toyosu Hospital  Tokyo Japan"},{"name":"Institute of Digestive and Liver Diseases St. Luke's Medical Center  Global City 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