{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:12:47Z","timestamp":1787238767363,"version":"build-2736575974"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Definitive palliation for achalasia is surgical myotomy; however, patients frequently undergo endoscopic treatments prior to myotomy. Surgeons may perceive myotomy to be more challenging after prior treatments, due to scarring and fusion of dissection planes, but outcomes compared to the treatment-na\u00efve remain unclear. Hence, we compared institutional Heller myotomy outcomes in patients who underwent pre-myotomy endoscopic treatments to those who did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From 1\/1\/2010 to 1\/1\/2020, 436 patients underwent Heller myotomy for achalasia at Cleveland Clinic, 101 (23%) of whom had prior endoscopic intervention(s): 39 (39%) pneumatic dilation, 57 (56%) botulinum toxin injection, and 5 (4.9%) both (Prior group). Propensity score matching generated two groups of 101 pairs. Short-term outcomes and longitudinal postoperative symptom palliation (Eckardt score\u2009\u2264\u20093), esophageal emptying at five minutes, and reintervention were assessed and compared with the treatment-na\u00efve (Na\u00efve group).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were no statistically significant differences in operative time, mucosal perforation, or length of stay between Prior and Na\u00efve groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u2009.12). At 5\u00a0years, the probability of symptom palliation was 83% in the Prior Group vs 81% in the Na\u00efve Group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.63) and complete esophageal emptying 23% vs 32% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.095). The cumulative number of reinterventions per 100 patients at 10\u00a0years was 7.9 in the Prior Group and 4.8 in the Na\u00efve Group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.13).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The perception of increased complexity of Heller myotomy in patients with prior endoscopic interventions does not translate to stastically significant differences in short- or long-term outcomes when compared to the treatment-na\u00efve. A subtle longitudinal pattern of suboptimal esophageal emptying and increased reintervention for patients with prior intervention(s), suggests that, when possible, up-front myotomy may be preferred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-025-11661-0","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T10:57:19Z","timestamp":1744714639000},"page":"3328-3336","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Heller myotomy in patients with prior endoscopic interventions vs the treatment-na\u00efve"],"prefix":"10.1007","volume":"39","author":[{"given":"Nethra","family":"Jain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John O.","family":"Barron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Toth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monisha","family":"Sudarshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhusudhan","family":"Sanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadhvika","family":"Ramji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurav","family":"Adhikari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudish C.","family":"Murthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene H.","family":"Blackstone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2479-7769","authenticated-orcid":false,"given":"Siva","family":"Raja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Cleveland Clinic Esophageal Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"Raymond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanthi","family":"Thota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Gabbard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"11661_CR1","doi-asserted-by":"publisher","first-page":"e14058","DOI":"10.1111\/nmo.14058","volume":"33","author":"R Yadlapati","year":"2021","unstructured":"Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, Babaei A, Mittal RK, Rommel N, Savarino E, Sifrim D, Smout A, Vaezi MF, Zerbib F, Akiyama J, Bhatia S, Bor S, Carlson DA, Chen JW, Cisternas D, Cock C, Coss-Adame E, de Bortoli N, Defilippi C, Fass R, Ghoshal UC, Gonlachanvit S, Hani A, Hebbard GS, Wook Jung K, Katz P, Katzka DA, Khan A, Kohn GP, Lazarescu A, Lengliner J, Mittal SK, Omari T, Park MI, Penagini R, Pohl D, Richter JE, Serra J, Sweis R, Tack J, Tatum RP, Tutuian R, Vela MF, Wong RK, Wu JC, Xiao Y, Pandolfino JE (2021) Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0\u00a9. 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