{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:35:37Z","timestamp":1792510537314,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"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":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Achalasia is a primary esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and absent peristalsis. Treatment options include Pneumatic Dilation, Laparoscopic Heller Myotomy, and Esophageal Peroral Endoscopic Myotomy (E-POEM). A focal distal esophageal dilation at the myotomy site, termed blown-out myotomy (BOM), has been reported in 9%\u00a0\u2013\u00a032% of patients and may be associated with reflux, esophageal retention, and treatment failure. The clinical significance of BOM remains unclear. This meta-analysis evaluated the prevalence and clinical characteristics of BOM following E-POEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of electronic databases and conference proceedings from inception through November 2025 identified prospective and retrospective studies reporting the prevalence or clinical features of BOM after E-POEM. The primary outcome was pooled BOM prevalence. Secondary outcomes included symptom severity (Eckardt score), myotomy characteristics, and associations with achalasia subtypes. Studies reporting\u2009\u2264\u20093 BOM cases or lacking extractable data were excluded. Pooled proportions were calculated using a fixed-effects model. Publication bias was assessed using the Begg\u2013Mazumdar test. Mean Eckardt scores were compared using an unpaired t-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four studies comprising 947 patients were included. The pooled prevalence of BOM was 11.16% (95% CI: 9.28%\u00a0\u201313.25%). No evidence of publication bias was detected (Kendall\u2019s tau-\n                      <jats:italic>b<\/jats:italic>\n                      \u2009=\u20090.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.75). Baseline characteristics were comparable between groups. Mean myotomy length was 10.39\u2009\u00b1\u20091.82\u00a0cm in the BOM group and 11.23\u2009\u00b1\u20091.46\u00a0cm in the non-BOM group. Pretreatment Eckardt scores were similar (6.67 vs 6.63), as were 3-month post\u2013E-POEM scores (2.05 vs 1.93). Pooled odds ratios for BOM were 0.73 (95% CI: 0.47\u20131.13) for type I achalasia, 0.79 (95% CI: 0.53\u20131.19) for type II, and 1.38 (95% CI: 0.80\u20132.38) for type III.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BOM occurs in a minority of patients following E-POEM. Across studies, BOM did not show consistent associations with symptoms or procedural characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12950-y","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:45:25Z","timestamp":1780508725000},"page":"5491-5497","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence and clinical characteristics of blown-out myotomy after E-POEM for achalasia: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9062-2484","authenticated-orcid":false,"given":"Yusuf","family":"Kagzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas Reddy","family":"Puli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"12950_CR1","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1001\/jama.2015.2996","volume":"313","author":"JE Pandolfino","year":"2015","unstructured":"Pandolfino JE, Gawron AJ (2015) Achalasia: a systematic review. 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Dr. Srinivas Reddy Puli has no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}