Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. Sep 21, 2026; 32(35): 118916
Published online Sep 21, 2026. doi: 10.3748/wjg.118916
Published online Sep 21, 2026. doi: 10.3748/wjg.118916
One tunnel, two pathologies: Tailoring submucosal tunnelling per-oral endoscopic myotomy in achalasia with epiphrenic diverticulum by septum morphology
Meer M Chisthi, Krishnakumar G Kuttanchettiyar, Department of General Surgery, Government Medical College Kollam, Parippally 691574, Kerala, India
Sindhu Viswanath, Department of Otorhinolaryngology, Government Medical College Trivandrum, Thiruvananthapuram 695011, Kerala, India
Co-first authors: Meer M Chisthi and Krishnakumar G Kuttanchettiyar.
Author contributions: Chisthi MM and Kuttanchettiyar KG drafted the manuscript and they contribute equally to this study as co-first authors; Viswanath S and Chisthi MM acquired and analyzed the data; Viswanath S and Kuttanchettiyar KG vetted the manuscript; all authors approved the final version to be published and agreed to be accountable for all aspects of the work.
AI contribution statement: The only AI tool used was DeepSeek (version from March 2025). We used it selectively on paragraphs that felt awkward or unclear - primarily in the Introduction and Discussion sections. After editing, we compared the AI-polished version against our original draft line by line to ensure no factual or logical changes were introduced. We take full responsibility for every claim, citation, and conclusion in this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest regarding the publication of this paper.
Corresponding author: Sindhu Viswanath, MS, Assistant Professor, Department of Otorhino
Received: January 14, 2026
Revised: February 16, 2026
Accepted: March 10, 2026
Published online: September 21, 2026
Processing time: 213 Days and 17.9 Hours
Revised: February 16, 2026
Accepted: March 10, 2026
Published online: September 21, 2026
Processing time: 213 Days and 17.9 Hours
Core Tip
Core Tip: Management of achalasia with epiphrenic diverticulum is evolving. A one-size-fits-all septotomy is no longer justified. Intra-procedural endoscopic phenotyping allows for a selective approach: Division of a functionally obstructive muscular septum when present and standard myotomy alone when absent. This precision strategy, supported by recent meta-analytic data showing high treatment success for per-oral endoscopic myotomy in epiphrenic diverticula, achieves comparable outcomes to universal septotomy while minimizing overtreatment and its associated risks.