Bibliographic record
Abstract
Introduction: Esophageal achalasia is most commonly treated with endoscopic dilation or laparoscopic Heller myotomy.Peroral endoscopic myotomy (POEM) has recently been described as a novel treatment for achalasia in humans.The aim of this study was to assess the clinical effectiveness and safety of POEM for treating esophageal achalasia performed in a single tertiary center within 10 years.Materials and Methods: Between June 2010 and May 2019, POEM was performed in 1140 consecutive patients with achalasia.POEM procedure consisted of the following step: firstly, submucosal tunnel was created and extended below the lower esophageal sphincter (LES) onto the gastric cardia after a mucosal incision was made; then endoscopic myotomy of circular muscle bundles was done; finally, the mucosal entry was closed by hemostatic clips.The Eckardt score and manometry were used to evaluate the outcomes.Results: POEM was successfully performed in 1115 of 1140 cases (97.8%).Mean procedure time was 42.1 min (range 33-86) and mean myotomy length was 9.5 cm (range 7-16).Mucosal perforations occurred in 23 (2%) patients during submucosal tunnel creation, major bleeding occurred in 15 (1.3%) patients, and 29 (2.5%) patients suffered pneumothorax immediate after procedure.All the complications were managed conservatively.During a mean follow-up period of 49.3 months (range 5-89 months), treatment success was achieved in 1005/1140 patients (88.2%).Mean LES pressure was 57.5 mmHg (29.2-83.1)and 15.6 mmHg (5.2-23.1)before and after the procedure (P = 0.000), respectively.Mean Eckardt score was 6.1 (4-11, median 6) and 0.6 (0-3, median 1) before and after POEM, respectively (P = 0.000).In a multivariate analysis, no independent predictor of treatment success was found.215 patient (18.9%) developed mild reflux symptoms and required intermittent medication with proton pump inhibitors during the follow-up.Conclusion: Our study demonstrated that POEM is a safe, and effective treatment for achalasia during a long-term follow-up.Further studies are warranted to compare the clinical outcomes of POEM with other treatment modalities.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.574 | 0.546 |
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; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
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".