One tunnel, two pathologies: Tailoring submucosal tunnelling per-oral endoscopic myotomy in achalasia with epiphrenic diverticulum by septum morphology

Table 1 Reported clinical outcomes and parameters for surgical and endoscopic treatments of achalasia with epiphrenic diverticulum

Treatment modality	Clinical success (%)	Hospital stays (day)	Notable adverse events	Key considerations
POEM with selective septotomy (ED + S)	88.9-94.2[17,19]	2.3-3.5[17]	Mucosal perforation (5%-15%)[17,22]	Minimally invasive; success hinges on accurate septum phenotyping
POEM without septotomy (ED - S)	90.0-94.2[17,19]	2.0-3.0[19]	Mucosal perforation (approximately 10%)[22]	Avoids septotomy-related risks; suitable for non-septated diverticula
Laparoscopic Heller myotomy + diverticulectomy	83.0-90.0[6,20]	5-7[1]	Anastomotic leak (5%-10%), recurrent diverticulum (10%-15%)[7,8]	Gold-standard surgery; allows concurrent fundoplication
Open transthoracic surgery	70.0-85.0[21]	8-10[21]	Pneumonia, leaks, prolonged recovery[21]	High morbidity; reserved for complex redo cases

POEM: Per-oral endoscopic myotomy; ED: Epiphrenic diverticula; S: Septum.