{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:35:01Z","timestamp":1792510501843,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Blown\u2010out myotomy (BOM) is a diverticular\u2010like change that develops at the myotomy site after surgical or peroral endoscopic myotomy (POEM). This study aimed to elucidate BOM's incidence, clinical course, and risk factors after POEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This retrospective, single\u2010center study evaluated patients who underwent POEM for achalasia or non\u2010achalasia motility disorders at our institution between April 2015 and March 2023. Endoscopic grade at surveillance was classified as Grade 0, no diverticular\u2010like changes; Grade 1, mild diverticular\u2010like changes; Grade 2, obvious diverticular\u2010like changes with a septum; and Grade 3, obvious diverticular\u2010like changes with food retention. Grades 2 and 3 were defined as endoscopic BOM. The incidence and clinical course of BOM were evaluated using the Kaplan\u2013Meier method, and factors associated with BOM were assessed using univariate analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 598 patients, 28 (4.7%) developed BOM during the study period. The 1\u2010, 2\u2010, and 5\u2010year incidence rates of endoscopic BOM were 3.1%, 6.6%, and 8.1%, respectively. Progression of BOM grade mainly occurred between 1 and 3\u2009years after POEM and then plateaued in the Kaplan\u2013Meier curve. Male sex (71.4% vs. 48.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019), a thin esophageal muscle layer during myotomy (67.9% vs. 40.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and clinical reflux after POEM (78.6% vs. 36.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were significantly associated with BOM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The incidence of BOM after POEM is low. BOM grade progression occurred within 3\u2009years after POEM. Male sex, a thin esophageal muscle layer, and clinical reflux were associated with BOM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70018","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:30:32Z","timestamp":1756182632000},"page":"1323-1331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Course of Blown\u2010Out Myotomy After Peroral Endoscopic Myotomy in Patients With Achalasia\u2010Related Esophageal Motility Disorders"],"prefix":"10.1111","volume":"37","author":[{"given":"Hiroshi","family":"Tanabe","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Abe","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinwa","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1212-1905","authenticated-orcid":false,"given":"Hiroya","family":"Sakaguchi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chise","family":"Ueda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Nakai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitomi","family":"Hori","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Hoki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Urakami","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4315-4766","authenticated-orcid":false,"given":"Tetsuya","family":"Yoshizaki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Konan Medical Center  Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiaki","family":"Kawara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Konan Medical Center  Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Toyonaga","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Kobe University Hospital  Kobe 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Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T03:35:43Z","timestamp":1765769743000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/den.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":17,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/den.70018"],"URL":"https:\/\/doi.org\/10.1111\/den.70018","archive":["Portico"],"relation":{},"ISSN":["0915-5635","1443-1661"],"issn-type":[{"value":"0915-5635","type":"print"},{"value":"1443-1661","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"assertion":[{"value":"2025-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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