{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:29:49Z","timestamp":1777404589980,"version":"3.51.4"},"reference-count":47,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,12,28]],"date-time":"2017-12-28T00:00:00Z","timestamp":1514419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003711","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["105\u20102325\u2010B\u2010002\u2010041\u2010"],"award-info":[{"award-number":["105\u20102325\u2010B\u2010002\u2010041\u2010"]}],"id":[{"id":"10.13039\/501100003711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003711","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["103\u20102314\u2010B\u2010002\u2010045\u2010MY2"],"award-info":[{"award-number":["103\u20102314\u2010B\u2010002\u2010045\u2010MY2"]}],"id":[{"id":"10.13039\/501100003711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["106\u2010003411"],"award-info":[{"award-number":["106\u2010003411"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Patients with achalasia typically have thicker lower esophageal sphincter muscles, which can affect the distensibility of the esophagogastric junction. We aimed to assess whether these muscular features, measured using high\u2010frequency endoscopic ultrasound, affect treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive adult patients with suspected achalasia were enrolled prospectively. They underwent a comprehensive diagnostic workup, including endoscopic ultrasound. The thickness of the lower esophageal sphincter, including the internal circular and outer longitudinal muscles, was measured using a 12\u2010MHz ultrasonic miniprobe. Follow\u2010up was performed at 1\u00a0month and then at 6\u2010month intervals, after treatment. Treatment response was defined as a reduction in Eckardt score to \u22643 or an improvement in the height of the timed barium esophagogram of \u226550%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 29 patients who received pneumatic dilatation, all but one (96.6%) exhibited a good short\u2010term treatment response. At an average follow\u2010up time of 18.5 (12\u201355.5)\u00a0months, patients who had a mid\u2010term recurrence after pneumatic dilatation had a significantly thicker outer longitudinal muscle (1.8 [1.5\u20131.8] <jats:italic>vs<\/jats:italic> 0.9 [0.8\u20131.7]\u00a0mm, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.036), but not internal circular muscle (2.0 [1.9\u20132.5] <jats:italic>vs<\/jats:italic> 2.1 [1.2\u20132.7]\u00a0mm, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.874) or total lower esophageal sphincter (3.7 [3.5\u20134.4] <jats:italic>vs<\/jats:italic> 3.6 [2.0\u20134.1] mm, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.362). Patients with an outer longitudinal muscle \u22651.3\u00a0mm thick had a significantly lower mid\u2010term remission rate than others (36.3% <jats:italic>vs<\/jats:italic> 100%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Thickening of the outer longitudinal muscle at the lower esophageal sphincter is associated with poor mid\u2010term treatment outcomes for achalasia patients treated with pneumatic dilatation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.13816","type":"journal-article","created":{"date-parts":[[2017,5,5]],"date-time":"2017-05-05T16:04:40Z","timestamp":1494000280000},"page":"240-248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Muscular thickness of lower esophageal sphincter and therapeutic outcomes in achalasia: A prospective study using high\u2010frequency endoscopic ultrasound"],"prefix":"10.1111","volume":"33","author":[{"given":"Shih\u2010Wei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Taoyuan General Hospital, Ministry of Health and Welfare  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping\u2010Huei","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien\u2010Chuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Chih","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kao\u2010Lang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jang\u2010Ming","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi\u2010Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seng\u2010Kee","family":"Chuah","sequence":"additional","affiliation":[{"name":"Gastrointestinal Motility Unit, Division of Hepato\u2010Gastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming\u2010Shiang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiu\u2010Po","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.7.638"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i33.5421"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010502"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000216782.10502.47"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)91428-7"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(05)00986-9"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v12.i18.2858"},{"key":"e_1_2_6_9_1","first-page":"675","article-title":"Clinical application of endoscopic ultrasonography","volume":"85","author":"Nickl NJ","year":"1990","journal-title":"Am. J. Gastroenterol."},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365520510012118"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1012776"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1052-5157(18)30071-0"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-010-1318-4"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.4.485"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.2.9242756"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04816.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-009-0804-z"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.50.6.765"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(89)91644-2"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07587.x"},{"key":"e_1_2_6_22_1","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/0016-5085(90)91337-6","article-title":"Endoscopic ultrasonography in achalasia","volume":"98","author":"Ponsot P","year":"1990","journal-title":"Gastroenterology"},{"key":"e_1_2_6_23_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S1052-5157(18)30431-8","article-title":"The use of high frequency endoscopic ultrasonography probes in the evaluation of achalasia","volume":"5","author":"Miller LS","year":"1995","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(96)70132-3"},{"key":"e_1_2_6_25_1","doi-asserted-by":"crossref","first-page":"A48","DOI":"10.1055\/s-2007-1001467","article-title":"Endosonographic evaluation of the patient with achalasia","volume":"30","author":"Van Dam J","year":"1998","journal-title":"Endoscopy"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1010495"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1005659"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.184.3.1509056"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2009.06108.x"},{"key":"e_1_2_6_30_1","first-page":"134","article-title":"A case report of intraoperative endoscopic ultrasound during robotic assisted Heller myotomy for severe esophageal achalasia","volume":"163","author":"Abdel Khalek M","year":"2011","journal-title":"J. La State Med. Soc."},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.12432"},{"key":"e_1_2_6_32_1","doi-asserted-by":"crossref","unstructured":"Borhan\u2010Manesh F. M.J.Kaviani andA.R.Taghavi The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter not muscular disruption.Dis Esophagus 2015.","DOI":"10.1111\/dote.12314"},{"key":"e_1_2_6_33_1","first-page":"244A","article-title":"Assessment of esophageal muscle thickness in achalasia using a high frequency linear endoscopic ultrasound probe","volume":"38","author":"Trowers E","year":"1992","journal-title":"Gastrointest. Endosc."},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(95)70008-0"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.2.126"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.08.004"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2005.00693.x"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2003.029298"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(04)00123-5"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2011.17.1.9"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01639.x"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018886626144"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.05771.x"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-825659"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00311.2006"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664-015-0551-x"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(92)70431-3"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcg.0000155519.04253.ba"}],"container-title":["Journal of Gastroenterology and Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgh.13816","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgh.13816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T09:12:09Z","timestamp":1695978729000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jgh.13816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,28]]},"references-count":47,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1111\/jgh.13816"],"URL":"https:\/\/doi.org\/10.1111\/jgh.13816","archive":["Portico"],"relation":{},"ISSN":["0815-9319","1440-1746"],"issn-type":[{"value":"0815-9319","type":"print"},{"value":"1440-1746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,28]]},"assertion":[{"value":"2017-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-12-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}