A short 4-cm oesophageal myotomy relieves the obstructive symptoms of achalasia☆
Bibliographic record
Abstract
OBJECTIVE: Controversy still persists regarding the ideal length of myotomy to treat oesophageal achalasia. This investigation reports the effects of a short myotomy with an added partial fundoplication for reflux prevention. METHODS: From 1997 to 2007, 22 patients (13 men, 9 women, median age: 41 years) with achalasia underwent a 6-cm short myotomy (four oesophagus and two stomach) with a Belsey partial fundoplication by left thoracotomy. Assessments include clinical and radiological evaluation, radionuclide transit studies, manometry, 24-h pH and endoscopy. RESULTS: No morbidity and no mortality occurred. Median follow-up is 54 months (range: 4-139 months). Dysphagia present in all 22 patients left an episodic slow emptying sensation in three patients after operation (p<0.001). Fresh food regurgitation decreased significantly after the myotomy (17 pre-, four post-regurgitation, p<0.001). Heartburn present in four patients before the operation was recorded in nine patients postoperatively (p=0.179). Radiologically, barium stasis decreased significantly from 85% to 30% (p=0.007). No diverticular formation was seen in the myotomy zone. On the oesophageal scintigram, stasis at 2 min decreased from a median of 60% before the operation to 16% (p<0.001). The lower oesophageal sphincter (LOS) gradient decreased from 30 to 9.7 mmHg (p<0.001). LOS relaxation improved from 40% pre- to 93% postoperatively (p=0.003). Endoscopies and biopsies documented increased mucosal damage after the operation (one preoperative, 13 postoperative; p<0.001). CONCLUSIONS: When treating achalasia, the myotomy, despite being shortened in length, reduces the LOS gradient, relieves obstructive symptoms and improves oesophageal emptying. The LOS relaxation is improved. Complete coverage of the myotomysed zone by the fundus prevents diverticular formation. Oesophageal mucosal damage from reflux is significant despite the partial fundoplication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".