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Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0
Journal article
Blown-Out Myotomy: One Radiographic Phenotype, Multiple Biological Pathways
Journal of Gastrointestinal Surgery, Forthcoming
10 Sep 2026
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Abstract
Blown-out myotomy (BOM) has become one of the most debated postoperative findings following treatment for achalasia. Since its description as a distinct morphologic entity, BOM has increasingly been regarded as a mechanism of treatment failure [1]. The initial 2021 report also suggested that BOM may occur more frequently after laparoscopic Heller myotomy (LHM) than after peroral endoscopic myotomy (POEM). We propose that BOM is best understood not as a single pathophysiologic entity, but as a common radiographic phenotype arising from multiple biologically distinct postoperative processes. In this Surgical Perspective, we reexamine the existing literature through this framework and explore how technical and physiologic differences between LHM and POEM may influence BOM development, including whether the available evidence supports a true difference in risk between the two procedures.
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Details
- Title
- Blown-Out Myotomy: One Radiographic Phenotype, Multiple Biological Pathways
- Creators
- Shahin Ayazi (Corresponding Author) - Drexel University, SurgeryJohn Lipham - University of Southern CaliforniaJohn G. Hunter - Oregon Health & Science University
- Publication Details
- Journal of Gastrointestinal Surgery, Forthcoming
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Other Identifier
- 991022206779704721