{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T18:29:24Z","timestamp":1787596164976,"version":"build-2736575974"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aim<\/jats:title>\n Achalasia's insidious onset and nonspecific presentation contribute to diagnostic delays, often exceeding 20\u2009months from symptom onset to confirmation. The four\u2010domain CARS endoscopic score (Content, Anatomy, Resistance, Stasis) may expedite risk stratification. We performed a meta\u2010analysis to assess diagnostic accuracy, interobserver reliability, and treatment\u2010monitoring potential.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We searched PubMed, Embase, Web of Science, the Cochrane Library, and\n ClinicalTrials.gov<\/jats:ext-link>\n through June 2025. Study\u2010level 2\u2009\u00d7\u20092 contingency data were then synthesized using bivariate random\u2010effects models to derive pooled sensitivity, specificity, positive predictive value, and negative predictive value, generate HSROC curves, and construct Fagan nomograms at 5% and 25% pre\u2010test probabilities.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We screened 49 studies and ultimately included five studies encompassing 1112 patients with a mean age of 54.5\u2009years and overall achalasia prevalence of 31.7%. For a CARS threshold \u2265\u20094, pooled sensitivity was 0.73 (95% CI 0.69\u20130.78), specificity 1.00 (0.99\u20131.00), positive predictive value 0.99, and negative predictive value 0.88; employing a dual\u2010threshold strategy (CARS\u2009=\u20090 to rule out; \u2265\u20094 to rule in) further improved sensitivity to 0.95 (0.92\u20130.98), specificity to 0.99 (0.97\u20131.00), positive predictive value to 0.99, and negative predictive value to 0.96. The HSROC AUC approached 0.99, and moreover interobserver agreement was almost perfect with a pooled Cohen's\n \u03ba<\/jats:italic>\n \u2009=\u20090.84 (95% CI 0.76\u20130.91).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n CARS reliably stratifies patients into low\u2010risk (CARS\u2009=\u20090), moderate\u2010risk (1\u20133), and high\u2010risk (\u2265\u20094) groups facilitating deferred testing, targeted manometry, or prompt invasive evaluation while demonstrating excellent interobserver agreement, underscoring its clinical utility.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n PROSPERO number: CRD420251007005<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/nmo.70252","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:29:47Z","timestamp":1768832987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Performance and Reproducibility of the\n CARS<\/scp>\n Endoscopic Score in Achalasia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-941X","authenticated-orcid":false,"given":"Gedion Yilma","family":"Amdetsion","sequence":"first","affiliation":[{"name":"Department of Medicine Cook County Hospital Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Wei","family":"Pan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology UMASS Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiwot Gebeyehu","family":"Tebeje","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Washington University in St Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daksh","family":"Alhuwalia","sequence":"additional","affiliation":[{"name":"Department of Medicine Cook County Hospital Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyas","family":"Nandyal","sequence":"additional","affiliation":[{"name":"Department of Medicine Cook County Hospital Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena","family":"Yadlapati","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018855327960"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2024.05.001"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/dow004"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2007.01532.x"},{"key":"e_1_2_12_6_1","unstructured":"FLIP Registration 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