title: New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy.
abstract: OBJECTIVE
  To propose a new endoscopic classification of achalasia for selecting patients appropriate for undergoing peroral endoscopic myotomy (POEM).
  
  
  METHODS
  We screened out the data of patients with achalasia examined from October 2000 to September 2011 at our Digestive Endoscopic Center with endoscopic pictures clear enough to reveal the morphology of middle and lower esophagus. After analyzing the correlation between the endoscopic morphology of the esophageal lumen and POEM, we proposed a new endoscopic classification (Ling classification) of achalasia according to three kinds of endoscopically viewed structures: multi-ring structure, crescent-like structure and diverticulum structure. There were three types based on the criteria of Ling classification: type I, smooth without multi-ring, crescent-like structure or diverticulum structure; type II, with multi-ring or crescent-like structure but without diverticulum structure; and type III, with diverticulum structure. Type II was classified into three subtypes: Ling II(a), Ling II(b) and Ling II(c); and type III also had three subtypes: Ling III(l), Ling III(r) and Ling III(lr). Two endoscopists made a final decision upon mutual agreement through discussion if their separately recorded characteristics were different.
  
  
  RESULTS
  Among the 976 screened patients with achalasia, 636 patients with qualified endoscopic pictures were selected for the analysis, including 405 males and 231 females. The average age was 42.7 years, ranging from 6 to 93 years. Type I was the most commonly observed type of achalasia, accounting for 64.5% (410/636), and type III was the least commonly observed type of achalasia, accounting for 2.8% (18/636). And type II accounted for 32.7% (208/636) and subtype of Ling II(a), Ling II(b) and Ling II(c) accounted for 14.6% (93/636), 9.9% (63/636) and 8.2% (52/636), respectively. And subtype of Ling III(l), Ling III(r) and Ling III(lr) accounted for 0.8% (5/636), 0.3% (2/636) and 1.7% (11/636), respectively.
  
  
  CONCLUSIONS
  A new endoscopic classification of achalasia is proposed that might help in determining the proper candidates for POEM.
authors: Department of Gastroenterology, PLA General Hospital, Beijing 100853, China.
authors: Hui-Kai
authors: HK
authors: Li
authors: En-Qiang
authors: EQ
authors: Linghu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004931:Esophageal Achalasia / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D009626:Terminology as Topic; D055815:Young Adult
keywords: Achalasia; Classification; Endoscopy; Peroral endoscopic myotomy; Selection
references: Endoscopy. 2007 Sep;39(9):761-4
references: 17703382
references: Surg Endosc. 2012 Nov;26(11):3267-72
references: 22609984
references: Dig Dis Sci. 2009 Nov;54(11):2303-11
references: 19107596
references: N Engl J Med. 2011 May 12;364(19):1807-16
references: 21561346
references: Langenbecks Arch Surg. 2010 Nov;395(8):1093-9
references: 20845045
references: Dig Liver Dis. 2012 Dec;44(12):976-80
references: 22938702
references: Gastrointest Endosc Clin N Am. 2010 Jan;20(1):25-34, v-vi
references: 19951792
references: World J Gastroenterol. 2009 Oct 28;15(40):5000-9
references: 19859991
references: Endoscopy. 2010 Apr;42(4):265-71
references: 20354937
references: J Am Coll Surg. 2011 Dec;213(6):751-6
references: 21996484
references: Curr Gastroenterol Rep. 2011 Jun;13(3):219-25
references: 21424734
references: Curr Opin Gastroenterol. 2010 Jul;26(4):384-8
references: 20502326
references: Gastrointest Endosc. 1980 Feb;26(1):8-10
references: 7358270
references: Gastrointest Endosc. 2010 Dec;72(6):1309-11
references: 21111876
references: Am J Gastroenterol. 2012 Mar;107(3):411-7
references: 22068665
references: Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Sep;14(9):705-8
references: 21948538
references: J Gastrointest Surg. 2010 Feb;14 Suppl 1:S33-45
references: 19760373
references: Endoscopy. 2012;44 Suppl 2 UCTN:E215-6
references: 22622752
references: Scand J Surg. 2011;100(2):72-7
references: 21737381
references: J Gastrointest Surg. 2011 May;15(5):703-7
references: 21394546
references: J Neurogastroenterol Motil. 2011 Jan;17(1):48-53
references: 21369491
references: Dig Liver Dis. 2012 Oct;44(10):827-32
references: 22609465
references: Gastroenterology. 2008 Nov;135(5):1526-33
references: 18722376
references: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005046
references: 17054234