{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:55:56Z","timestamp":1790409356550,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T00:00:00Z","timestamp":1742169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007197","name":"U.S. Public Health Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007197","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Endoscopy can detect features indicative of esophageal dysmotility, but standardized approaches for diagnosing achalasia based on these findings remain limited. Recently, the CARS score was developed to address this gap. This study aimed to evaluate the diagnostic utility of endoscopy in identifying achalasia, using the STARD framework and current reference standards.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients with esophageal symptoms were prospectively enrolled from 2018 to 2023 and evaluated using endoscopy, esophageal manometry, FLIP panometry, and barium esophagram. The CARS score was assigned to endoscopic videos by two raters blinded to other clinical details. The diagnostic accuracy of the CARS score for predicting achalasia, based on Chicago Classification v4.0, was assessed through two interpretation methods: binary cutoffs for the total score and a classification tree model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>316 patients were included: 115 patients with achalasia (36%), 113 with normal motility (36%), and 88 with other manometric findings (28%). A CARS score \u2265\u20094 demonstrated 72% sensitivity and 99% specificity for achalasia, while a score \u2265\u20093 had 83% sensitivity and 96% specificity. The optimal classification tree had three levels (resistance score at the top, followed by anatomy and content scores, with hernia presence at the bottom) and had a sensitivity of 90% and a specificity 92% for achalasia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Endoscopy can accurately identify achalasia with high specificity using the CARS score. While motility testing to confirm an achalasia diagnosis remains essential prior to therapy, a high CARS score may help in the early identification of achalasia, especially in settings where motility testing is not readily available.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.70024","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T19:10:11Z","timestamp":1742238611000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Endoscopic Prediction of Achalasia: Putting the <scp>CART<\/scp> Before the <scp>CARS<\/scp>"],"prefix":"10.1111","volume":"37","author":[{"given":"Meng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gastroenterology The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)  Zhejiang Hangzhou China"},{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofer Z.","family":"Fass","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-7758","authenticated-orcid":false,"given":"Dustin A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panyavee","family":"Pitisuttithum","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"},{"name":"Department of Medicine Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Goudie","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"},{"name":"Division of Thoracic Surgery, Department of Surgery Universit\u00e9 de Montr\u00e9al  Montreal Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristjana","family":"Kristinsdottir","sequence":"additional","affiliation":[{"name":"Research &amp; Development, Department of Information Services Northwestern Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evandros","family":"Kaklamanos","sequence":"additional","affiliation":[{"name":"Research &amp; Development, Department of Information Services Northwestern Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mozziyar","family":"Etemadi","sequence":"additional","affiliation":[{"name":"Research &amp; Development, Department of Information Services Northwestern Medicine  Chicago Illinois USA"},{"name":"Department of Anesthesiology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh N.","family":"Keswani","sequence":"additional","affiliation":[{"name":"Kenneth C. Griffin Esophageal Center of Northwestern Medicine, Department of Medicine, Division of Gastroenterology and Hepatology Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton","family":"Ellison","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott &amp; White Research Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vani J. A.","family":"Konda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott &amp; White Research Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Kenneth C. 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