Li XM, Tao YR, Zeng FC, Chen Y. Letter to the Editor: To cut or not to cut-objective metrics in achalasia with septum-less diverticulum. World J Gastroenterol 2026; 32(34): 119182 [DOI: 10.3748/wjg.119182]
Corresponding Author of This Article
Yuan Chen, PhD, Doctor, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen 518060, Guangdong Province, China. chenyuanx2000@163.com
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Gastroenterology & Hepatology
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letter
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Li XM, Tao YR, Zeng FC, Chen Y. Letter to the Editor: To cut or not to cut-objective metrics in achalasia with septum-less diverticulum. World J Gastroenterol 2026; 32(34): 119182 [DOI: 10.3748/wjg.119182]
Yuan Chen, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, Guangdong Province, China
Co-first authors: Xin-Meng Li and Yong-Rui Tao.
Co-corresponding authors: Fan-Chun Zeng and Yuan Chen.
Author contributions: Chen Y designed the research; Li XM and Tao YR wrote the original draft of the manuscript; Zeng FC and Chen Y critically revised and polished the manuscript; Li XM and Tao YR contributed equally to this work and should be considered co-first authors; Zeng FC and Chen Y contributed equally as corresponding authors; all authors discussed the results, reviewed the manuscript, and approved the final version for publication.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Yuan Chen, PhD, Doctor, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, No. 1066 Xueyuan Avenue, Nanshan District, Shenzhen 518060, Guangdong Province, China. chenyuanx2000@163.com
Received: January 21, 2026 Revised: March 25, 2026 Accepted: April 23, 2026 Published online: September 14, 2026 Processing time: 210 Days and 11.4 Hours
Abstract
We read with great interest the study by Hao et al, published in the recent issue of the World Journal of Gastroenterology, regarding the simultaneous treatment of achalasia and epiphrenic diverticula (ED) via submucosal tunneling. While demonstrating technical proficiency in 31 patients, significant nosological ambiguities and methodological limitations warrant critical scrutiny. Our primary concern lies in the classification of the “ED without septum” (ED - S) cohort. Notably, 60% of patients in the ED - S group had undergone prior interventions, including Heller myotomy or peroral endoscopic myotomy. Conflating iatrogenic “blown-out myotomy” with primary “septum-less” diverticula is problematic, as their pathophysiology and management differ fundamentally. Secondly, the assessment relies heavily on subjective scoring (Eckardt score, gastroesophageal reflux questionnaire). Without paired pre- and post-operative high-resolution manometry or systematic endoscopic follow-up to assess silent reflux, it is difficult to validate whether septotomy provides additional physiologic benefit over myotomy alone, or if the reported safety profile is entirely accurate. Future studies must integrate objective metrics to rigorously validate these endoscopic strategies.
Core Tip: We critically appraise the phenotypic classification proposed by Hao et al, contending that the entity termed “diverticulum without septum” most plausibly represents an iatrogenic blown-out myotomy, given the high prevalence of prior endoscopic interventions in this cohort. Furthermore, we question the asserted necessity of septotomy, as recent multicenter evidence suggests standard myotomy alone is equally effective for epiphrenic diverticula, while mitigating the additional procedural risks. Distinguishing between primary pathology and secondary adverse events, paired with objective functional follow-up, is crucial for selecting the appropriate endoscopic strategy.
