F6publishing.blob.core.windows.net



Name of journal: World Journal of GastroenterologyManuscript NO: 42452Manuscript type: MinireviewsEsophagogastric junction outflow obstruction: Where are we now in diagnosis and management?Samo S et al. Esophagogastric junction outflow obstructionSalih Samo, Emad QayedSalih Samo, Emad Qayed, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United StatesORCID number: Salih Samo (0000-0003-1254-3670); Emad Qayed (0000-0003-2129-7694).Author contributions: Samo S drafted and revised the manuscript; Qayed E drafted and revised the manuscript; all authors read and approved the final version of the manuscript.Conflict-of-interest statement: The authors declare no conflicts of interest.Open-Access: This article is an open-access?article?which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance?with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: : Invited?manuscriptCorresponding author to: Emad Qayed, MD, MPH, FACG, Assistant Professor, Chief of Gastroenterology, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, United States. eqayed@emory.eduTelephone: +1-404-7781685 Fax: +1-404-7781681Received: September 25, 2018Peer-review started: September 25, 2018First decision: November 8, 2018Revised: December 6, 2018Accepted: December 14, 2018Article in press: December 15, 2018Published online: January 28, 2019AbstractEsophagogastric junction outflow obstruction (EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility disorders. This entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. This reveals evidence of obstruction at the esophagogastric junction, manifested by an elevated integrated relaxation pressure (IRP) above a cutoff value (IRP threshold varies by the manometric technology and catheter used), with preserved peristalsis. Further tests like endoscopy, timed barium esophagram, and cross-sectional imaging can help further elucidate the underlying etiology and rule out mechanical causes. Treatment is tailored to the underlying cause. Similar to achalasia, treatment targeting lower esophageal sphincter disruption like pneumatic dilation, peroral endoscopic myotomy, and botulinum injection are used in patients with functional EGJOO and persistent symptoms.Key words: Esophagogastric junction outflow obstruction; high-resolution manometry? The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.Core tip: Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis and is considered a major motility disorder. In this condition, it is important to rule out treatable causes of mechanical obstruction at the gastro-esophageal junction. In functional EGJOO, there is no obvious mechanical or structural cause of obstruction. In this condition, presenting symptoms like dysphagia and manometry metrics like IRP and distal contractile integral are associated with persistence of symptoms upon follow up. These patients may benefit from early intervention to disrupt the functional obstruction at the lower esophageal sphincter, using treatment modalities similar to achalasia. Citation: Samo S, Qayed E. Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management? World J Gastroenterol 2019; 25(4): 411-417 URL: DOI: invention of high-resolution manometry (HRM) has substantially redefined the landscape of esophageal motility disorders. The assessment of esophagogastric junction (EGJ) obstructive physiology is fundamental in the evaluation of esophageal motility disorders, which is determined by an elevated integrated relaxation pressure (IRP). According to the Chicago Classification of esophageal motility disorders, version 3.0 (CC v3.0), a median IRP threshold of ≥ 15 mmHg on HRM performed in a supine position is indicative of failed deglutitive lower esophageal sphincter (LES) relaxationPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxLCAyXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdl

cHRzdHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48

YXV0aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+

PGF1dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+

PGF1dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9h

dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBv

ZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5p

dmVyc2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5U

aGUgQ2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVy

cywgdjMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8

L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90

aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0

aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1

bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48

YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dh

c3Ryb2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAm

YW1wOyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48

dm9sdW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmlj

YXRpb24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFn

ZWFsIE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3Bh

dGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdl

IEludGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5v

bWV0cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tl

eXdvcmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90

aWxpdHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0

cnk8L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5

d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+

RmViPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5Q

TUM0MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJv

bmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1u

dW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRl

cj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5H

aG9zaDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051bT42MDwvUmVjTnVtPjxyZWNvcmQ+

PHJlYy1udW1iZXI+NjA8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRi

LWlkPSJ0OWRlMDl4NWFhOTB2N2VwdHN0dmQwYW9mcGF4NWF4c3JmZmEiIHRpbWVzdGFtcD0iMTQ1

ODk2MDIwMyI+NjA8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBB

cnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkdob3No

LCBTLiBLLjwvYXV0aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48YXV0aG9y

PlJpY2UsIEouPC9hdXRob3I+PGF1dGhvcj5DbGFya2UsIEouIE8uPC9hdXRob3I+PGF1dGhvcj5L

d2lhdGVrLCBNLjwvYXV0aG9yPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRo

b3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwdC4gb2YgTWVkaWNpbmUsIEZlaW5i

ZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXYuLCBDaGljYWdvLCBJTCA2

MDYxMSwgVVNBLiBzLWdob3NoQG5vcnRod2VzdGVybi5lZHU8L2F1dGgtYWRkcmVzcz48dGl0bGVz

Pjx0aXRsZT5JbXBhaXJlZCBkZWdsdXRpdGl2ZSBFR0ogcmVsYXhhdGlvbiBpbiBjbGluaWNhbCBl

c29waGFnZWFsIG1hbm9tZXRyeTogYSBxdWFudGl0YXRpdmUgYW5hbHlzaXMgb2YgNDAwIHBhdGll

bnRzIGFuZCA3NSBjb250cm9sczwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5BbSBKIFBoeXNpb2wg

R2FzdHJvaW50ZXN0IExpdmVyIFBoeXNpb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkFt

ZXJpY2FuIGpvdXJuYWwgb2YgcGh5c2lvbG9neS4gR2FzdHJvaW50ZXN0aW5hbCBhbmQgbGl2ZXIg

cGh5c2lvbG9neTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFt

ZXJpY2FuIEpvdXJuYWwgb2YgUGh5c2lvbG9neTogR2FzdHJvaW50ZXN0aW5hbCBhbmQgTGl2ZXIg

UGh5c2lvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkFtLiBKLiBQaHlzaW9sLiBHYXN0cm9pbnRl

c3QuIExpdmVyIFBoeXNpb2wuPC9hYmJyLTE+PGFiYnItMj5BbSBKIFBoeXNpb2wgR2FzdHJvaW50

ZXN0IExpdmVyIFBoeXNpb2w8L2FiYnItMj48YWJici0zPkFtZXJpY2FuIEpvdXJuYWwgb2YgUGh5

c2lvbG9neTogR2FzdHJvaW50ZXN0aW5hbCAmYW1wOyBMaXZlciBQaHlzaW9sb2d5PC9hYmJyLTM+

PC9wZXJpb2RpY2FsPjxwYWdlcz5HODc4LTg1PC9wYWdlcz48dm9sdW1lPjI5Mzwvdm9sdW1lPjxu

dW1iZXI+NDwvbnVtYmVyPjxlZGl0aW9uPjIwMDcvMDgvMTE8L2VkaXRpb24+PGtleXdvcmRzPjxr

ZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdv

cmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5BZ2VkLCA4MCBhbmQgb3Zlcjwva2V5d29yZD48a2V5

d29yZD5EZWdsdXRpdGlvbi8qcGh5c2lvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IEFjaGFsYXNpYS9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0

cmljIEp1bmN0aW9uLypwaHlzaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29y

ZD5NYW5vbWV0cnkvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdv

cmQ+PGtleXdvcmQ+TXVzY2xlIFJlbGF4YXRpb24vKnBoeXNpb2xvZ3k8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPk9jdDwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAxOTMtMTg1NyAoUHJpbnQpJiN4RDswMTkzLTE4NTc8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTc2OTAxNzI8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTUyL2FqcGdpLjAwMjUyLjIwMDc8L2VsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUt

ZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRl

PjwvRW5kTm90ZT5=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxLCAyXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdl

cHRzdHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48

YXV0aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+

PGF1dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+

PGF1dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9h

dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBv

ZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5p

dmVyc2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5U

aGUgQ2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVy

cywgdjMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8

L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90

aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0

aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1

bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48

YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dh

c3Ryb2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAm

YW1wOyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48

dm9sdW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmlj

YXRpb24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFn

ZWFsIE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3Bh

dGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdl

IEludGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5v

bWV0cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tl

eXdvcmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90

aWxpdHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0

cnk8L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5

d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+

RmViPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5Q

TUM0MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJv

bmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1u

dW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRl

cj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5H

aG9zaDwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJlY051bT42MDwvUmVjTnVtPjxyZWNvcmQ+

PHJlYy1udW1iZXI+NjA8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRi

LWlkPSJ0OWRlMDl4NWFhOTB2N2VwdHN0dmQwYW9mcGF4NWF4c3JmZmEiIHRpbWVzdGFtcD0iMTQ1

ODk2MDIwMyI+NjA8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBB

cnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkdob3No

LCBTLiBLLjwvYXV0aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48YXV0aG9y

PlJpY2UsIEouPC9hdXRob3I+PGF1dGhvcj5DbGFya2UsIEouIE8uPC9hdXRob3I+PGF1dGhvcj5L

d2lhdGVrLCBNLjwvYXV0aG9yPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRo

b3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwdC4gb2YgTWVkaWNpbmUsIEZlaW5i

ZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXYuLCBDaGljYWdvLCBJTCA2

MDYxMSwgVVNBLiBzLWdob3NoQG5vcnRod2VzdGVybi5lZHU8L2F1dGgtYWRkcmVzcz48dGl0bGVz

Pjx0aXRsZT5JbXBhaXJlZCBkZWdsdXRpdGl2ZSBFR0ogcmVsYXhhdGlvbiBpbiBjbGluaWNhbCBl

c29waGFnZWFsIG1hbm9tZXRyeTogYSBxdWFudGl0YXRpdmUgYW5hbHlzaXMgb2YgNDAwIHBhdGll

bnRzIGFuZCA3NSBjb250cm9sczwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5BbSBKIFBoeXNpb2wg

R2FzdHJvaW50ZXN0IExpdmVyIFBoeXNpb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkFt

ZXJpY2FuIGpvdXJuYWwgb2YgcGh5c2lvbG9neS4gR2FzdHJvaW50ZXN0aW5hbCBhbmQgbGl2ZXIg

cGh5c2lvbG9neTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFt

ZXJpY2FuIEpvdXJuYWwgb2YgUGh5c2lvbG9neTogR2FzdHJvaW50ZXN0aW5hbCBhbmQgTGl2ZXIg

UGh5c2lvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkFtLiBKLiBQaHlzaW9sLiBHYXN0cm9pbnRl

c3QuIExpdmVyIFBoeXNpb2wuPC9hYmJyLTE+PGFiYnItMj5BbSBKIFBoeXNpb2wgR2FzdHJvaW50

ZXN0IExpdmVyIFBoeXNpb2w8L2FiYnItMj48YWJici0zPkFtZXJpY2FuIEpvdXJuYWwgb2YgUGh5

c2lvbG9neTogR2FzdHJvaW50ZXN0aW5hbCAmYW1wOyBMaXZlciBQaHlzaW9sb2d5PC9hYmJyLTM+

PC9wZXJpb2RpY2FsPjxwYWdlcz5HODc4LTg1PC9wYWdlcz48dm9sdW1lPjI5Mzwvdm9sdW1lPjxu

dW1iZXI+NDwvbnVtYmVyPjxlZGl0aW9uPjIwMDcvMDgvMTE8L2VkaXRpb24+PGtleXdvcmRzPjxr

ZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdv

cmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5BZ2VkLCA4MCBhbmQgb3Zlcjwva2V5d29yZD48a2V5

d29yZD5EZWdsdXRpdGlvbi8qcGh5c2lvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IEFjaGFsYXNpYS9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0

cmljIEp1bmN0aW9uLypwaHlzaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29y

ZD5NYW5vbWV0cnkvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdv

cmQ+PGtleXdvcmQ+TXVzY2xlIFJlbGF4YXRpb24vKnBoeXNpb2xvZ3k8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPk9jdDwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAxOTMtMTg1NyAoUHJpbnQpJiN4RDswMTkzLTE4NTc8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTc2OTAxNzI8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTUyL2FqcGdpLjAwMjUyLjIwMDc8L2VsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUt

ZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRl

PjwvRW5kTm90ZT5=

ADDIN EN.CITE.DATA [1,2]. The cutoff values for IRP are technology dependent and vary per type of instrument (solid-state vs. water perfused). Furthermore, it has been shown that IRP is significantly lower when HRM is performed in the upright sitting position as compared to the supine positionPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kbyBDYXJtbzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT4yMzYxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzNdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM2MTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM3MTI2MzY4Ij4yMzYxPC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5kbyBDYXJtbywgRy4gQy48L2F1dGhv

cj48YXV0aG9yPkphZmFyaSwgSi48L2F1dGhvcj48YXV0aG9yPlNpZnJpbSwgRC48L2F1dGhvcj48

YXV0aG9yPmRlIE9saXZlaXJhLCBSLiBCLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9y

cz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUsIE1lZGljYWwgU2Nob29sIG9m

IFJpYmVpcmFvIFByZXRvLCBVbml2ZXJzaXR5IG9mIFNhbyBQYXVsbywgUmliZWlyYW8gUHJldG8s

IEJyYXppbC48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Ob3JtYWwgZXNvcGhhZ2VhbCBw

cmVzc3VyZSB0b3BvZ3JhcGh5IG1ldHJpY3MgZm9yIGRhdGEgZGVyaXZlZCBmcm9tIHRoZSBTYW5k

aGlsbC1VbmlzZW5zb3IgaGlnaC1yZXNvbHV0aW9uIG1hbm9tZXRyeSBhc3NlbWJseSBpbiBzdXBp

bmUgYW5kIHNpdHRpbmcgcG9zaXRpb25zPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3RpdGxl

cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwt

dGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9m

ZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkg

U29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1wZXJp

b2RpY2FsPjxwYWdlcz4yODUtOTI8L3BhZ2VzPjx2b2x1bWU+Mjc8L3ZvbHVtZT48bnVtYmVyPjI8

L251bWJlcj48ZWRpdGlvbj4yMDE1LzAxLzA2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5B

ZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkRlZ2x1dGl0aW9u

PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy8qcGh5c2lvbG9neTwva2V5d29yZD48a2V5d29y

ZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkltYWdl

IEludGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZC8qbWV0aG9kczwva2V5d29yZD48a2V5

d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbm9tZXRyeS8qaW5zdHJ1bWVudGF0aW9uPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lz

PC9rZXl3b3JkPjxrZXl3b3JkPipQb3N0dXJlPC9rZXl3b3JkPjxrZXl3b3JkPllvdW5nIEFkdWx0

PC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWd1czwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29s

dXRpb24gbWFub21ldHJ5PC9rZXl3b3JkPjxrZXl3b3JkPm5vcm1hbCB2YWx1ZXM8L2tleXdvcmQ+

PGtleXdvcmQ+cG9zaXRpb248L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNTwv

eWVhcj48cHViLWRhdGVzPjxkYXRlPkZlYjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2Ju

PjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yNTU1NzUyNTwvYWNjZXNzaW9uLW51bT48

dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEyNTAxPC9l

bGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVt

b3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv

Q2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kbyBDYXJtbzwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT4yMzYxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzNdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM2MTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM3MTI2MzY4Ij4yMzYxPC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5kbyBDYXJtbywgRy4gQy48L2F1dGhv

cj48YXV0aG9yPkphZmFyaSwgSi48L2F1dGhvcj48YXV0aG9yPlNpZnJpbSwgRC48L2F1dGhvcj48

YXV0aG9yPmRlIE9saXZlaXJhLCBSLiBCLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9y

cz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUsIE1lZGljYWwgU2Nob29sIG9m

IFJpYmVpcmFvIFByZXRvLCBVbml2ZXJzaXR5IG9mIFNhbyBQYXVsbywgUmliZWlyYW8gUHJldG8s

IEJyYXppbC48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5Ob3JtYWwgZXNvcGhhZ2VhbCBw

cmVzc3VyZSB0b3BvZ3JhcGh5IG1ldHJpY3MgZm9yIGRhdGEgZGVyaXZlZCBmcm9tIHRoZSBTYW5k

aGlsbC1VbmlzZW5zb3IgaGlnaC1yZXNvbHV0aW9uIG1hbm9tZXRyeSBhc3NlbWJseSBpbiBzdXBp

bmUgYW5kIHNpdHRpbmcgcG9zaXRpb25zPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3RpdGxl

cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwt

dGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9m

ZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkg

U29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1wZXJp

b2RpY2FsPjxwYWdlcz4yODUtOTI8L3BhZ2VzPjx2b2x1bWU+Mjc8L3ZvbHVtZT48bnVtYmVyPjI8

L251bWJlcj48ZWRpdGlvbj4yMDE1LzAxLzA2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5B

ZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkRlZ2x1dGl0aW9u

PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy8qcGh5c2lvbG9neTwva2V5d29yZD48a2V5d29y

ZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkltYWdl

IEludGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZC8qbWV0aG9kczwva2V5d29yZD48a2V5

d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbm9tZXRyeS8qaW5zdHJ1bWVudGF0aW9uPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lz

PC9rZXl3b3JkPjxrZXl3b3JkPipQb3N0dXJlPC9rZXl3b3JkPjxrZXl3b3JkPllvdW5nIEFkdWx0

PC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWd1czwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29s

dXRpb24gbWFub21ldHJ5PC9rZXl3b3JkPjxrZXl3b3JkPm5vcm1hbCB2YWx1ZXM8L2tleXdvcmQ+

PGtleXdvcmQ+cG9zaXRpb248L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNTwv

eWVhcj48cHViLWRhdGVzPjxkYXRlPkZlYjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2Ju

PjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yNTU1NzUyNTwvYWNjZXNzaW9uLW51bT48

dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEyNTAxPC9l

bGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVt

b3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv

Q2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA [3]. The threshold of 15 mmHg used in the CC is for the Sierra design, which is currently acquired by Medtronic (Medtronic Inc. Minnesota, USA)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE.DATA [1]. The CC categorizes the obstruction at the EGJ into two groups based on peristalsis pattern: 1) achalasia (with its subtypes) with absence of peristalsis and 2) EGJ outflow obstruction (EGJOO) with preserved peristalsis (fragmented or normal). The EGJOO is considered a major motility disorder in the CCPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE.DATA [1].Etiology of EGJOOA variety of conditions can lead to manometric findings consistent with EGJOO. Potential etiologies for EGJOO are summarized in table 1PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+

PFJlY051bT4yMzQwPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzQtOF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzQwPC9y

ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1

cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM3NjY2ODEiPjIzNDA8L2tl

eT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVm

LXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkthaHJpbGFzLCBQLiBKLjwvYXV0

aG9yPjxhdXRob3I+QnJlZGVub29yZCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPkNhcmxzb24sIEQu

IEEuPC9hdXRob3I+PGF1dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjwvYXV0aG9ycz48

L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUsIEZlaW5i

ZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHksIENoaWNhZ28s

IElsbGlub2lzLiBFbGVjdHJvbmljIGFkZHJlc3M6IHAta2FocmlsYXNAbm9ydGh3ZXN0ZXJuLmVk

dS4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgQWNh

ZGVtaWMgTWVkaWNhbCBDZW50cmUsIEFtc3RlcmRhbSwgVGhlIE5ldGhlcmxhbmRzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdl

c3Rlcm4gVW5pdmVyc2l0eSwgQ2hpY2FnbywgSWxsaW5vaXMuPC9hdXRoLWFkZHJlc3M+PHRpdGxl

cz48dGl0bGU+QWR2YW5jZXMgaW4gTWFuYWdlbWVudCBvZiBFc29waGFnZWFsIE1vdGlsaXR5IERp

c29yZGVyczwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRv

bDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBh

bmQgaGVwYXRvbG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9m

IHRoZSBBbWVyaWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hbHQtdGl0bGU+

PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0

b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBh

dG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFt

ZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L3BlcmlvZGlj

YWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9s

PC9mdWxsLXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRv

bG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVy

aWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9hbHQtcGVyaW9k

aWNhbD48ZWRpdGlvbj4yMDE4LzA0LzI4PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5EeXNw

aGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnM8L2tl

eXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ3VzPC9rZXl3b3JkPjxrZXl3b3JkPkhpZ2gtUmVzb2x1dGlv

biBNYW5vbWV0cnk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxODwveWVhcj48

cHViLWRhdGVzPjxkYXRlPkFwciAyNDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1

NDItMzU2NTwvaXNibj48YWNjZXNzaW9uLW51bT4yOTcwMjI5NjwvYWNjZXNzaW9uLW51bT48dXJs

cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5jZ2guMjAxOC4wNC4w

MjY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxN

PC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNv

cmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+S2FocmlsYXM8L0F1dGhvcj48WWVhcj4yMDE4PC9ZZWFy

PjxSZWNOdW0+MjM0MDwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MDwvcmVjLW51bWJl

cj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1

OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY2NjgxIj4yMzQwPC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5DYXJsc29uLCBELiBBLjwvYXV0

aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmli

dXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBGZWluYmVyZyBTY2hv

b2wgb2YgTWVkaWNpbmUsIE5vcnRod2VzdGVybiBVbml2ZXJzaXR5LCBDaGljYWdvLCBJbGxpbm9p

cy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFzQG5vcnRod2VzdGVybi5lZHUuJiN4RDtE

ZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhlcGF0b2xvZ3ksIEFjYWRlbWljIE1l

ZGljYWwgQ2VudHJlLCBBbXN0ZXJkYW0sIFRoZSBOZXRoZXJsYW5kcy4mI3hEO0RlcGFydG1lbnQg

b2YgTWVkaWNpbmUsIEZlaW5iZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVu

aXZlcnNpdHksIENoaWNhZ28sIElsbGlub2lzLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxl

PkFkdmFuY2VzIGluIE1hbmFnZW1lbnQgb2YgRXNvcGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnM8

L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L3NlY29u

ZGFyeS10aXRsZT48YWx0LXRpdGxlPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0

b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1l

cmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWx0LXRpdGxlPjwvdGl0bGVz

PjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9mdWxs

LXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRvbG9neSA6

IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBH

YXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQt

cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvZnVsbC10

aXRsZT48YWJici0xPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3kgOiB0

aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1lcmljYW4gR2Fz

dHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PGVk

aXRpb24+MjAxOC8wNC8yODwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RHlzcGhhZ2lhPC9r

ZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzPC9rZXl3b3JkPjxr

ZXl3b3JkPkVzb3BoYWd1czwva2V5d29yZD48a2V5d29yZD5IaWdoLVJlc29sdXRpb24gTWFub21l

dHJ5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTg8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5BcHIgMjQ8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTQyLTM1NjU8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+Mjk3MDIyOTY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDE2L2ouY2doLjIwMTguMDQuMDI2PC9lbGVj

dHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3Rl

LWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0

ZT48Q2l0ZT48QXV0aG9yPk9rZWtlPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48UmVjTnVtPjIz

NDE8L1JlY051bT48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNDE8L3JlYy1udW1iZXI+PGZvcmVpZ24t

a2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4

dzlhdnAiIHRpbWVzdGFtcD0iMTUzMzkzODc0OSI+MjM0MTwva2V5PjwvZm9yZWlnbi1rZXlzPjxy

ZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3Jz

PjxhdXRob3JzPjxhdXRob3I+T2tla2UsIEYuIEMuPC9hdXRob3I+PGF1dGhvcj5SYWphLCBTLjwv

YXV0aG9yPjxhdXRob3I+THluY2gsIEsuIEwuPC9hdXRob3I+PGF1dGhvcj5EaGFsbGEsIFMuPC9h

dXRob3I+PGF1dGhvcj5OYW5kd2FuaSwgTS48L2F1dGhvcj48YXV0aG9yPlN0ZWluLCBFLiBNLjwv

YXV0aG9yPjxhdXRob3I+Q2hhbmRlciBSb2xhbmQsIEIuPC9hdXRob3I+PGF1dGhvcj5LaGFzaGFi

LCBNLiBBLjwvYXV0aG9yPjxhdXRob3I+U2F4ZW5hLCBQLjwvYXV0aG9yPjxhdXRob3I+S3VtYmhh

cmksIFYuPC9hdXRob3I+PGF1dGhvcj5BaHVqYSwgTi4gSy48L2F1dGhvcj48YXV0aG9yPkNsYXJr

ZSwgSi4gTy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5E

aXZpc2lvbiBvZiBIb3NwaXRhbCBNZWRpY2luZSwgVGhlIEpvaG5zIEhvcGtpbnMgVW5pdmVyc2l0

eSBTY2hvb2wgb2YgTWVkaWNpbmUsIEJhbHRpbW9yZSwgTUQsIFVTQS4mI3hEO0RpdmlzaW9uIG9m

IEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgRW1vcnkgVW5pdmVyc2l0eSBTY2hv

b2wgb2YgTWVkaWNpbmUsIEF0bGFudGEsIEdBLCBVU0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9l

bnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFVuaXZlcnNpdHkgb2YgUGVubnN5bHZhbmlhIFNj

aG9vbCBvZiBNZWRpY2luZSwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLiYjeEQ7RGl2aXNpb24gb2Yg

R2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBUaGUgSm9obnMgSG9wa2lucyBVbml2

ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYjeEQ7RGl2aXNp

b24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBTdGFuZm9yZCBVbml2ZXJz

aXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgU3RhbmZvcmQsIENBLCBVU0EuJiN4RDtEaXZpc2lvbiBv

ZiBHYXN0cm9lbnRlcm9sb2d5LCBSb3lhbCBQcmluY2UgQWxmcmVkIEhvc3BpdGFsLCBTeWRuZXks

IE5TVywgQXVzdHJhbGlhLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPldoYXQgaXMgdGhl

IGNsaW5pY2FsIHNpZ25pZmljYW5jZSBvZiBlc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0Zmxv

dyBvYnN0cnVjdGlvbj8gZXZhbHVhdGlvbiBvZiA2MCBwYXRpZW50cyBhdCBhIHRlcnRpYXJ5IHJl

ZmVycmFsIGNlbnRlcjwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wg

TW90aWw8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBh

bmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJv

aW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGlj

YWw+PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJy

LTE+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3Vy

bmFsIG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2Fi

YnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJv

ZW50ZXJvbCBNb3RpbDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBh

bmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJv

aW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48dm9s

dW1lPjI5PC92b2x1bWU+PG51bWJlcj42PC9udW1iZXI+PGVkaXRpb24+MjAxNy8wNC8xMTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5BZ2VkLCA4MCBh

bmQgb3Zlcjwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIERpc2Vhc2VzL2NvbXBsaWNhdGlv

bnMvKmRpYWdub3Npcy90aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdvZ2FzdHJpYyBK

dW5jdGlvbi8qcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29y

ZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5UZXJ0aWFyeSBDYXJlIENlbnRlcnM8L2tl

eXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdvcmQ+PGtleXdvcmQ+ZHlzcGhh

Z2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBvdXRmbG93IG9ic3RydWN0aW9u

IChFR0pPTyk8L2tleXdvcmQ+PGtleXdvcmQ+aGlnaC1yZXNvbHV0aW9uIGVzb3BoYWdlYWwgcHJl

c3N1cmUgdG9wb2dyYXBoeSAoSFJFUFQpPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFy

PjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5KdW48L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRl

cz48aXNibj4xMzUwLTE5MjU8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjgzOTM0Mzc8L2FjY2Vzc2lv

bi1udW0+PHVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4x

MzA2MTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5O

TE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3Jl

Y29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1ll

YXI+PFJlY051bT4yMzM5PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4yMzM5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdlOXQ1

YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM3NjU5NjUiPjIzMzk8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNjaHVwYWNrLCBELjwvYXV0aG9yPjxhdXRo

b3I+S2F0emthLCBELiBBLjwvYXV0aG9yPjxhdXRob3I+R2VubywgRC4gTS48L2F1dGhvcj48YXV0

aG9yPlJhdmksIEsuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl

c3M+RGVwYXJ0bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBNYXlvIENs

aW5pYywgUm9jaGVzdGVyLCBNTiwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlRo

ZSBjbGluaWNhbCBzaWduaWZpY2FuY2Ugb2YgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gYW5kIGh5cGVyY29udHJhY3RpbGUgZXNvcGhhZ3VzIGluIGhpZ2ggcmVz

b2x1dGlvbiBlc29waGFnZWFsIG1hbm9tZXRyeTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2wgTW90aWw8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUg

RXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90

aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9m

dWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRo

ZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGls

aXR5IFNvY2lldHk8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRp

dGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2Fz

dHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUg

RXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQt

cGVyaW9kaWNhbD48cGFnZXM+MS05PC9wYWdlcz48dm9sdW1lPjI5PC92b2x1bWU+PG51bWJlcj4x

MDwvbnVtYmVyPjxlZGl0aW9uPjIwMTcvMDUvMjY8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3Jk

PkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2Vh

bCBNb3RpbGl0eSBEaXNvcmRlcnMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzPC9rZXl3b3JkPjxr

ZXl3b3JkPkVzb3BoYWdvZ2FzdHJpYyBKdW5jdGlvbi9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdv

cmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxl

PC9rZXl3b3JkPjxrZXl3b3JkPk1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdl

ZDwva2V5d29yZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0

cnVjdGlvbjwva2V5d29yZD48a2V5d29yZD5oeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1czwva2V5

d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE3PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+

T2N0PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjI4NTQ0NjcwPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48ZWxlY3Ryb25p

Yy1yZXNvdXJjZS1udW0+MTAuMTExMS9ubW8uMTMxMDU8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+

PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+UmF0

dWFwbGk8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNOdW0+MjM1MjwvUmVjTnVtPjxyZWNv

cmQ+PHJlYy1udW1iZXI+MjM1MjwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJF

TiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1w

PSIxNTM2NTI1MDY1Ij4yMzUyPC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9Ikpv

dXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhv

cj5SYXR1YXBsaSwgU2hpdmEgSy48L2F1dGhvcj48YXV0aG9yPkNyb3dlbGwsIE1pY2hhZWwgRC48

L2F1dGhvcj48YXV0aG9yPkRpQmFpc2UsIEpvaG4gSy48L2F1dGhvcj48YXV0aG9yPlZlbGEsIE1h

cmNlbG8gRi48L2F1dGhvcj48YXV0aG9yPlJhbWlyZXosIEZyYW5jaXNjbyBDLjwvYXV0aG9yPjxh

dXRob3I+QnVyZGljaywgR2VvcmdlIEUuPC9hdXRob3I+PGF1dGhvcj5MYWN5LCBCcmlhbiBFLjwv

YXV0aG9yPjxhdXRob3I+TXVycmF5LCBKb3NlcGggQS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250

cmlidXRvcnM+PHRpdGxlcz48dGl0bGU+T3Bpb2lkLUluZHVjZWQgRXNvcGhhZ2VhbCBEeXNmdW5j

dGlvbiAoT0lFRCkgaW4gUGF0aWVudHMgb24gQ2hyb25pYyBPcGlvaWRzPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPlRoZSBBbWVyaWNhbiBKb3VybmFsIE9mIEdhc3Ryb2VudGVyb2xvZ3k8L3NlY29u

ZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2Vu

dGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9l

bnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxwYWdlcz45Nzk8L3BhZ2VzPjx2b2x1bWU+

MTEwPC92b2x1bWU+PGRhdGVzPjx5ZWFyPjIwMTU8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT4wNi8w

Mi9vbmxpbmU8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48cHVibGlzaGVyPkFtZXJpY2FuIENv

bGxlZ2Ugb2YgR2FzdHJvZW50ZXJvbG9neTwvcHVibGlzaGVyPjx3b3JrLXR5cGU+RXNvcGhhZ3Vz

PC93b3JrLXR5cGU+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly9keC5kb2kub3JnLzEw

LjEwMzgvYWpnLjIwMTUuMTU0PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMDM4L2FqZy4yMDE1LjE1NDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1u

dW0+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+S2FocmlsYXM8L0F1dGhvcj48WWVhcj4y

MDE3PC9ZZWFyPjxSZWNOdW0+MjM3MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM3Mjwv

cmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZk

NXI3ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTQzNjc5NTY1Ij4yMzcyPC9r

ZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3Jl

Zi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1

dGhvcj48YXV0aG9yPkthdHprYSwgRC48L2F1dGhvcj48YXV0aG9yPlJpY2h0ZXIsIEouIEUuPC9h

dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBv

ZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1l

ZGljaW5lLCBDaGljYWdvLCBJbGxpbm9pcy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFz

QG5vcnRod2VzdGVybi5lZHUuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rl

cm4gVW5pdmVyc2l0eSBGZWluYmVyZyBTY2hvb2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlu

b2lzLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNsaW5pY2FsIFByYWN0aWNlIFVwZGF0

ZTogVGhlIFVzZSBvZiBQZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXkgaW4gQWNoYWxhc2lhOiBF

eHBlcnQgUmV2aWV3IGFuZCBCZXN0IFByYWN0aWNlIEFkdmljZSBGcm9tIHRoZSBBR0EgSW5zdGl0

dXRlPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L3NlY29uZGFyeS10

aXRsZT48YWx0LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVy

aW9kaWNhbD48ZnVsbC10aXRsZT5HYXN0cm9lbnRlcm9sb2d5PC9mdWxsLXRpdGxlPjxhYmJyLTE+

R2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1

bGwtdGl0bGU+R2FzdHJvZW50ZXJvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkdhc3Ryb2VudGVy

b2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjA1LTEyMTE8L3BhZ2VzPjx2

b2x1bWU+MTUzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxNy8xMC8xMTwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvZGlhZ25vc2lz

L3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnaXRpcywg

UGVwdGljL2RydWcgdGhlcmFweS9ldGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Nj

b3B5L2FkdmVyc2UgZWZmZWN0cy9tZXRob2RzLypzdGFuZGFyZHM8L2tleXdvcmQ+PGtleXdvcmQ+

RXNvcGhhZ3VzL3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5IdW1h

bnM8L2tleXdvcmQ+PGtleXdvcmQ+TGFwYXJvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vdXRo

PC9rZXl3b3JkPjxrZXl3b3JkPk5hdHVyYWwgT3JpZmljZSBFbmRvc2NvcGljIFN1cmdlcnkvYWR2

ZXJzZSBlZmZlY3RzL21ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5QYXRpZW50

IFNlbGVjdGlvbjwva2V5d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9r

ZXl3b3JkPjxrZXl3b3JkPlByb3RvbiBQdW1wIEluaGliaXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9r

ZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQg

T3V0Y29tZTwva2V5d29yZD48a2V5d29yZD4qQWNoYWxhc2lhPC9rZXl3b3JkPjxrZXl3b3JkPipF

c29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVyczwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNv

bHV0aW9uIE1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD4qUGVyLU9yYWwgRW5kb3Njb3BpYyBN

eW90b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1k

YXRlcz48ZGF0ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDE2LTUwODU8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+Mjg5ODkwNTk8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxjdXN0b20yPlBNQzU2NzAwMTM8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTMxMTk8L2N1c3Rv

bTY+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwNTMvai5nYXN0cm8uMjAxNy4xMC4wMDE8

L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9y

ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+

PC9DaXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+

PFJlY051bT4yMzQwPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzQtOF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzQwPC9y

ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1

cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM3NjY2ODEiPjIzNDA8L2tl

eT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVm

LXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkthaHJpbGFzLCBQLiBKLjwvYXV0

aG9yPjxhdXRob3I+QnJlZGVub29yZCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPkNhcmxzb24sIEQu

IEEuPC9hdXRob3I+PGF1dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjwvYXV0aG9ycz48

L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUsIEZlaW5i

ZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHksIENoaWNhZ28s

IElsbGlub2lzLiBFbGVjdHJvbmljIGFkZHJlc3M6IHAta2FocmlsYXNAbm9ydGh3ZXN0ZXJuLmVk

dS4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgQWNh

ZGVtaWMgTWVkaWNhbCBDZW50cmUsIEFtc3RlcmRhbSwgVGhlIE5ldGhlcmxhbmRzLiYjeEQ7RGVw

YXJ0bWVudCBvZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdl

c3Rlcm4gVW5pdmVyc2l0eSwgQ2hpY2FnbywgSWxsaW5vaXMuPC9hdXRoLWFkZHJlc3M+PHRpdGxl

cz48dGl0bGU+QWR2YW5jZXMgaW4gTWFuYWdlbWVudCBvZiBFc29waGFnZWFsIE1vdGlsaXR5IERp

c29yZGVyczwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRv

bDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBh

bmQgaGVwYXRvbG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9m

IHRoZSBBbWVyaWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hbHQtdGl0bGU+

PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0

b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBh

dG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFt

ZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L3BlcmlvZGlj

YWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9s

PC9mdWxsLXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRv

bG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVy

aWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9hbHQtcGVyaW9k

aWNhbD48ZWRpdGlvbj4yMDE4LzA0LzI4PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5EeXNw

aGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnM8L2tl

eXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ3VzPC9rZXl3b3JkPjxrZXl3b3JkPkhpZ2gtUmVzb2x1dGlv

biBNYW5vbWV0cnk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxODwveWVhcj48

cHViLWRhdGVzPjxkYXRlPkFwciAyNDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1

NDItMzU2NTwvaXNibj48YWNjZXNzaW9uLW51bT4yOTcwMjI5NjwvYWNjZXNzaW9uLW51bT48dXJs

cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5jZ2guMjAxOC4wNC4w

MjY8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxN

PC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNv

cmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+S2FocmlsYXM8L0F1dGhvcj48WWVhcj4yMDE4PC9ZZWFy

PjxSZWNOdW0+MjM0MDwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MDwvcmVjLW51bWJl

cj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1

OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY2NjgxIj4yMzQwPC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5DYXJsc29uLCBELiBBLjwvYXV0

aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmli

dXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBGZWluYmVyZyBTY2hv

b2wgb2YgTWVkaWNpbmUsIE5vcnRod2VzdGVybiBVbml2ZXJzaXR5LCBDaGljYWdvLCBJbGxpbm9p

cy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFzQG5vcnRod2VzdGVybi5lZHUuJiN4RDtE

ZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhlcGF0b2xvZ3ksIEFjYWRlbWljIE1l

ZGljYWwgQ2VudHJlLCBBbXN0ZXJkYW0sIFRoZSBOZXRoZXJsYW5kcy4mI3hEO0RlcGFydG1lbnQg

b2YgTWVkaWNpbmUsIEZlaW5iZXJnIFNjaG9vbCBvZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVu

aXZlcnNpdHksIENoaWNhZ28sIElsbGlub2lzLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxl

PkFkdmFuY2VzIGluIE1hbmFnZW1lbnQgb2YgRXNvcGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnM8

L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L3NlY29u

ZGFyeS10aXRsZT48YWx0LXRpdGxlPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0

b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1l

cmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWx0LXRpdGxlPjwvdGl0bGVz

PjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9mdWxs

LXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRvbG9neSA6

IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBH

YXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQt

cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvZnVsbC10

aXRsZT48YWJici0xPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3kgOiB0

aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1lcmljYW4gR2Fz

dHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PGVk

aXRpb24+MjAxOC8wNC8yODwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RHlzcGhhZ2lhPC9r

ZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzPC9rZXl3b3JkPjxr

ZXl3b3JkPkVzb3BoYWd1czwva2V5d29yZD48a2V5d29yZD5IaWdoLVJlc29sdXRpb24gTWFub21l

dHJ5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTg8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5BcHIgMjQ8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTQyLTM1NjU8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+Mjk3MDIyOTY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDE2L2ouY2doLjIwMTguMDQuMDI2PC9lbGVj

dHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3Rl

LWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0

ZT48Q2l0ZT48QXV0aG9yPk9rZWtlPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48UmVjTnVtPjIz

NDE8L1JlY051bT48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNDE8L3JlYy1udW1iZXI+PGZvcmVpZ24t

a2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4

dzlhdnAiIHRpbWVzdGFtcD0iMTUzMzkzODc0OSI+MjM0MTwva2V5PjwvZm9yZWlnbi1rZXlzPjxy

ZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3Jz

PjxhdXRob3JzPjxhdXRob3I+T2tla2UsIEYuIEMuPC9hdXRob3I+PGF1dGhvcj5SYWphLCBTLjwv

YXV0aG9yPjxhdXRob3I+THluY2gsIEsuIEwuPC9hdXRob3I+PGF1dGhvcj5EaGFsbGEsIFMuPC9h

dXRob3I+PGF1dGhvcj5OYW5kd2FuaSwgTS48L2F1dGhvcj48YXV0aG9yPlN0ZWluLCBFLiBNLjwv

YXV0aG9yPjxhdXRob3I+Q2hhbmRlciBSb2xhbmQsIEIuPC9hdXRob3I+PGF1dGhvcj5LaGFzaGFi

LCBNLiBBLjwvYXV0aG9yPjxhdXRob3I+U2F4ZW5hLCBQLjwvYXV0aG9yPjxhdXRob3I+S3VtYmhh

cmksIFYuPC9hdXRob3I+PGF1dGhvcj5BaHVqYSwgTi4gSy48L2F1dGhvcj48YXV0aG9yPkNsYXJr

ZSwgSi4gTy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5E

aXZpc2lvbiBvZiBIb3NwaXRhbCBNZWRpY2luZSwgVGhlIEpvaG5zIEhvcGtpbnMgVW5pdmVyc2l0

eSBTY2hvb2wgb2YgTWVkaWNpbmUsIEJhbHRpbW9yZSwgTUQsIFVTQS4mI3hEO0RpdmlzaW9uIG9m

IEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgRW1vcnkgVW5pdmVyc2l0eSBTY2hv

b2wgb2YgTWVkaWNpbmUsIEF0bGFudGEsIEdBLCBVU0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9l

bnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFVuaXZlcnNpdHkgb2YgUGVubnN5bHZhbmlhIFNj

aG9vbCBvZiBNZWRpY2luZSwgUGhpbGFkZWxwaGlhLCBQQSwgVVNBLiYjeEQ7RGl2aXNpb24gb2Yg

R2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBUaGUgSm9obnMgSG9wa2lucyBVbml2

ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYjeEQ7RGl2aXNp

b24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBTdGFuZm9yZCBVbml2ZXJz

aXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgU3RhbmZvcmQsIENBLCBVU0EuJiN4RDtEaXZpc2lvbiBv

ZiBHYXN0cm9lbnRlcm9sb2d5LCBSb3lhbCBQcmluY2UgQWxmcmVkIEhvc3BpdGFsLCBTeWRuZXks

IE5TVywgQXVzdHJhbGlhLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPldoYXQgaXMgdGhl

IGNsaW5pY2FsIHNpZ25pZmljYW5jZSBvZiBlc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0Zmxv

dyBvYnN0cnVjdGlvbj8gZXZhbHVhdGlvbiBvZiA2MCBwYXRpZW50cyBhdCBhIHRlcnRpYXJ5IHJl

ZmVycmFsIGNlbnRlcjwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wg

TW90aWw8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBh

bmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJv

aW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGlj

YWw+PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJy

LTE+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3Vy

bmFsIG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2Fi

YnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJv

ZW50ZXJvbCBNb3RpbDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBh

bmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJv

aW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48dm9s

dW1lPjI5PC92b2x1bWU+PG51bWJlcj42PC9udW1iZXI+PGVkaXRpb24+MjAxNy8wNC8xMTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5BZ2VkLCA4MCBh

bmQgb3Zlcjwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIERpc2Vhc2VzL2NvbXBsaWNhdGlv

bnMvKmRpYWdub3Npcy90aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdvZ2FzdHJpYyBK

dW5jdGlvbi8qcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29y

ZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5UZXJ0aWFyeSBDYXJlIENlbnRlcnM8L2tl

eXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdvcmQ+PGtleXdvcmQ+ZHlzcGhh

Z2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBvdXRmbG93IG9ic3RydWN0aW9u

IChFR0pPTyk8L2tleXdvcmQ+PGtleXdvcmQ+aGlnaC1yZXNvbHV0aW9uIGVzb3BoYWdlYWwgcHJl

c3N1cmUgdG9wb2dyYXBoeSAoSFJFUFQpPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFy

PjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5KdW48L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRl

cz48aXNibj4xMzUwLTE5MjU8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjgzOTM0Mzc8L2FjY2Vzc2lv

bi1udW0+PHVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4x

MzA2MTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5O

TE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3Jl

Y29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1ll

YXI+PFJlY051bT4yMzM5PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4yMzM5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdlOXQ1

YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM3NjU5NjUiPjIzMzk8L2tleT48L2Zv

cmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+

PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNjaHVwYWNrLCBELjwvYXV0aG9yPjxhdXRo

b3I+S2F0emthLCBELiBBLjwvYXV0aG9yPjxhdXRob3I+R2VubywgRC4gTS48L2F1dGhvcj48YXV0

aG9yPlJhdmksIEsuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJl

c3M+RGVwYXJ0bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBNYXlvIENs

aW5pYywgUm9jaGVzdGVyLCBNTiwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlRo

ZSBjbGluaWNhbCBzaWduaWZpY2FuY2Ugb2YgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gYW5kIGh5cGVyY29udHJhY3RpbGUgZXNvcGhhZ3VzIGluIGhpZ2ggcmVz

b2x1dGlvbiBlc29waGFnZWFsIG1hbm9tZXRyeTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2wgTW90aWw8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUg

RXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90

aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9m

dWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRo

ZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGls

aXR5IFNvY2lldHk8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRp

dGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2Fz

dHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUg

RXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQt

cGVyaW9kaWNhbD48cGFnZXM+MS05PC9wYWdlcz48dm9sdW1lPjI5PC92b2x1bWU+PG51bWJlcj4x

MDwvbnVtYmVyPjxlZGl0aW9uPjIwMTcvMDUvMjY8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3Jk

PkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2Vh

bCBNb3RpbGl0eSBEaXNvcmRlcnMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzPC9rZXl3b3JkPjxr

ZXl3b3JkPkVzb3BoYWdvZ2FzdHJpYyBKdW5jdGlvbi9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdv

cmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxl

PC9rZXl3b3JkPjxrZXl3b3JkPk1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdl

ZDwva2V5d29yZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0

cnVjdGlvbjwva2V5d29yZD48a2V5d29yZD5oeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1czwva2V5

d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE3PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+

T2N0PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjI4NTQ0NjcwPC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48ZWxlY3Ryb25p

Yy1yZXNvdXJjZS1udW0+MTAuMTExMS9ubW8uMTMxMDU8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+

PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+UmF0

dWFwbGk8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNOdW0+MjM1MjwvUmVjTnVtPjxyZWNv

cmQ+PHJlYy1udW1iZXI+MjM1MjwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJF

TiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1w

PSIxNTM2NTI1MDY1Ij4yMzUyPC9rZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9Ikpv

dXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhv

cj5SYXR1YXBsaSwgU2hpdmEgSy48L2F1dGhvcj48YXV0aG9yPkNyb3dlbGwsIE1pY2hhZWwgRC48

L2F1dGhvcj48YXV0aG9yPkRpQmFpc2UsIEpvaG4gSy48L2F1dGhvcj48YXV0aG9yPlZlbGEsIE1h

cmNlbG8gRi48L2F1dGhvcj48YXV0aG9yPlJhbWlyZXosIEZyYW5jaXNjbyBDLjwvYXV0aG9yPjxh

dXRob3I+QnVyZGljaywgR2VvcmdlIEUuPC9hdXRob3I+PGF1dGhvcj5MYWN5LCBCcmlhbiBFLjwv

YXV0aG9yPjxhdXRob3I+TXVycmF5LCBKb3NlcGggQS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250

cmlidXRvcnM+PHRpdGxlcz48dGl0bGU+T3Bpb2lkLUluZHVjZWQgRXNvcGhhZ2VhbCBEeXNmdW5j

dGlvbiAoT0lFRCkgaW4gUGF0aWVudHMgb24gQ2hyb25pYyBPcGlvaWRzPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPlRoZSBBbWVyaWNhbiBKb3VybmFsIE9mIEdhc3Ryb2VudGVyb2xvZ3k8L3NlY29u

ZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2Vu

dGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9l

bnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxwYWdlcz45Nzk8L3BhZ2VzPjx2b2x1bWU+

MTEwPC92b2x1bWU+PGRhdGVzPjx5ZWFyPjIwMTU8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT4wNi8w

Mi9vbmxpbmU8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48cHVibGlzaGVyPkFtZXJpY2FuIENv

bGxlZ2Ugb2YgR2FzdHJvZW50ZXJvbG9neTwvcHVibGlzaGVyPjx3b3JrLXR5cGU+RXNvcGhhZ3Vz

PC93b3JrLXR5cGU+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly9keC5kb2kub3JnLzEw

LjEwMzgvYWpnLjIwMTUuMTU0PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMDM4L2FqZy4yMDE1LjE1NDwvZWxlY3Ryb25pYy1yZXNvdXJjZS1u

dW0+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+S2FocmlsYXM8L0F1dGhvcj48WWVhcj4y

MDE3PC9ZZWFyPjxSZWNOdW0+MjM3MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM3Mjwv

cmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZk

NXI3ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTQzNjc5NTY1Ij4yMzcyPC9r

ZXk+PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3Jl

Zi10eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1

dGhvcj48YXV0aG9yPkthdHprYSwgRC48L2F1dGhvcj48YXV0aG9yPlJpY2h0ZXIsIEouIEUuPC9h

dXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBv

ZiBNZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1l

ZGljaW5lLCBDaGljYWdvLCBJbGxpbm9pcy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFz

QG5vcnRod2VzdGVybi5lZHUuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rl

cm4gVW5pdmVyc2l0eSBGZWluYmVyZyBTY2hvb2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlu

b2lzLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNsaW5pY2FsIFByYWN0aWNlIFVwZGF0

ZTogVGhlIFVzZSBvZiBQZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXkgaW4gQWNoYWxhc2lhOiBF

eHBlcnQgUmV2aWV3IGFuZCBCZXN0IFByYWN0aWNlIEFkdmljZSBGcm9tIHRoZSBBR0EgSW5zdGl0

dXRlPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L3NlY29uZGFyeS10

aXRsZT48YWx0LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVy

aW9kaWNhbD48ZnVsbC10aXRsZT5HYXN0cm9lbnRlcm9sb2d5PC9mdWxsLXRpdGxlPjxhYmJyLTE+

R2FzdHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1

bGwtdGl0bGU+R2FzdHJvZW50ZXJvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkdhc3Ryb2VudGVy

b2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjA1LTEyMTE8L3BhZ2VzPjx2

b2x1bWU+MTUzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxNy8xMC8xMTwv

ZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvZGlhZ25vc2lz

L3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnaXRpcywg

UGVwdGljL2RydWcgdGhlcmFweS9ldGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Nj

b3B5L2FkdmVyc2UgZWZmZWN0cy9tZXRob2RzLypzdGFuZGFyZHM8L2tleXdvcmQ+PGtleXdvcmQ+

RXNvcGhhZ3VzL3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5IdW1h

bnM8L2tleXdvcmQ+PGtleXdvcmQ+TGFwYXJvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vdXRo

PC9rZXl3b3JkPjxrZXl3b3JkPk5hdHVyYWwgT3JpZmljZSBFbmRvc2NvcGljIFN1cmdlcnkvYWR2

ZXJzZSBlZmZlY3RzL21ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5QYXRpZW50

IFNlbGVjdGlvbjwva2V5d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9r

ZXl3b3JkPjxrZXl3b3JkPlByb3RvbiBQdW1wIEluaGliaXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9r

ZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQg

T3V0Y29tZTwva2V5d29yZD48a2V5d29yZD4qQWNoYWxhc2lhPC9rZXl3b3JkPjxrZXl3b3JkPipF

c29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVyczwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNv

bHV0aW9uIE1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD4qUGVyLU9yYWwgRW5kb3Njb3BpYyBN

eW90b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1k

YXRlcz48ZGF0ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDE2LTUwODU8

L2lzYm4+PGFjY2Vzc2lvbi1udW0+Mjg5ODkwNTk8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxz

PjxjdXN0b20yPlBNQzU2NzAwMTM8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTMxMTk8L2N1c3Rv

bTY+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwNTMvai5nYXN0cm8uMjAxNy4xMC4wMDE8

L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9y

ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+

PC9DaXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE.DATA [4-8]. The majority of these disorders involve mechanical obstruction at the EGJ that could be subtle and missed during the initial evaluation with endoscopy. It is very important to carefully review endoscopic records and consider repeat endoscopy, if warranted, to exclude hiatal hernia, post-surgical changes, and intraluminal processes such as strictures in the distal esophagus and EOE before labeling someone with functional EGJOO.Presentation and Diagnosis of EGJOOThe EGJOO varies in its presentation. The diagnosis is made on HRM while the patient is usually being evaluated for esophageal symptoms such as dysphagia, heartburn and/or regurgitation, chest pain, and epigastric pain. However, the diagnosis of EGJOO can be an incidental finding on HRM during evaluation for different indications such as routine manometry prior to anti-reflux proceduresPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [6].The diagnosis of EGJOO is usually reached after performing endoscopic and functional tests of the esophagus. The evaluation of esophageal symptoms usually begins with upper endoscopy, if not previously performed, to assess for mechanical causes for the presenting symptoms. The endoscopic findings may range from normal upper endoscopy with normal peristalsis and LES, tight LES, esophagitis, hiatal hernia, tumors at the EGJ, and eosinophilic esophagitis (EoE) findings like edema, rings, exudates, furrows, and strictures. It is important to carefully assess the EGJ during endoscopy for any visible lesions or abnormalities on both forward and retroflexed views. A finding of an epiphrenic diverticulum is suggestive of increased EGJ pressure and foam (saliva) and stasis in the esophagus suggests dysmotility. If the endoscopy is unrevealing for a mechanical obstruction, the HRM is the reasonable next test to perform. The HRM findings include an elevated median IRP ≥ 15 mmHg (or a different designated cutoff value based on the device used) of ten supine liquid test swallows with preserved peristalsis (figure 1). The term “functional EGJOO” is used when there is no obvious mechanical cause for the obstruction. In achalasia, the IRP is elevated, but in contrast to EGJOO, there is failed peristalsis or absence of normal peristalsisPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+

PFJlY051bT40OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjQ5PC9yZWMtbnVt

YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0idDlkZTA5eDVhYTkwdjdlcHRz

dHZkMGFvZnBheDVheHNyZmZhIiB0aW1lc3RhbXA9IjE0NTgyNDE5MDkiPjQ5PC9rZXk+PC9mb3Jl

aWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxj

b250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhvcj48YXV0

aG9yPkJyZWRlbm9vcmQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5Gb3gsIE0uPC9hdXRob3I+PGF1

dGhvcj5HeWF3YWxpLCBDLiBQLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1

dGhvcj5TbW91dCwgQS4gSi48L2F1dGhvcj48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVy

c2l0eSwgQ2hpY2FnbywgSUwsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUg

Q2hpY2FnbyBDbGFzc2lmaWNhdGlvbiBvZiBlc29waGFnZWFsIG1vdGlsaXR5IGRpc29yZGVycywg

djMuMDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxp

dHkgOiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5h

bCBNb3RpbGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBNb3RpbGl0eTwvZnVsbC10aXRsZT48YWJi

ci0xPk5ldXJvZ2FzdHJvZW50ZXJvbC4gTW90aWwuPC9hYmJyLTE+PGFiYnItMj5OZXVyb2dhc3Ry

b2VudGVyb2wgTW90aWw8L2FiYnItMj48YWJici0zPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSAmYW1w

OyBNb3RpbGl0eTwvYWJici0zPjwvcGVyaW9kaWNhbD48cGFnZXM+MTYwLTc0PC9wYWdlcz48dm9s

dW1lPjI3PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MjAxNC8xMi8wNDwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvY2xhc3NpZmljYXRp

b24vZGlhZ25vc2lzL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFs

IE1vdGlsaXR5IERpc29yZGVycy9jbGFzc2lmaWNhdGlvbi8qZGlhZ25vc2lzL3BoeXNpb3BhdGhv

bG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlIElu

dGVycHJldGF0aW9uLCBDb21wdXRlci1Bc3Npc3RlZDwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0

cnkvKm1ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5hY2hhbGFzaWE8L2tleXdv

cmQ+PGtleXdvcmQ+ZHlzcGhhZ2lhPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwgbW90aWxp

dHkgZGlzb3JkZXJzPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2gtcmVzb2x1dGlvbiBtYW5vbWV0cnk8

L2tleXdvcmQ+PGtleXdvcmQ+aW5lZmZlY3RpdmUgZXNvcGhhZ2VhbCBtb3RpbGl0eTwva2V5d29y

ZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE1PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+RmVi

PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Np

b24tbnVtPjI1NDY5NTY5PC9hY2Nlc3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM0

MzA4NTAxPC9jdXN0b20yPjxjdXN0b202Pk5JSE1TNjQxMTMyPC9jdXN0b202PjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMjQ3NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+

PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48

bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE.DATA [1].Clinical symptoms and HRM metrics may predict persistence of symptoms in functional EGJOO patients. Presence of dysphagia on presentation and elevated IRP (max 32.1 vs 26.2 mmHg) and DCI (max 10353 vs 5352 mmHg.s.cm) on HRM have been shown to predict persistence of dysphagia in patients with EGJOO on follow upPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [6]. These metrics can also help identify a subset of patients who may benefit from early LES directed therapy. A maximum DCI threshold of 11000 mmHg.s.cm showed a positive predictive value of 82% for identifying patients with dysphagia on follow up. Hence, increasing IRP and DCI suggest a higher likelihood of symptoms persistence. The combination of IRP and DCI metrics in predicting the persistence of symptoms points toward that the symptoms in functional EGJOO are the result of increased resistance at the EGJ with peristaltic dysfunctionPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [6], which may represent early or incompletely expressed achalasiaPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2hlcmVyPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48

UmVjTnVtPjIzNTA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bOV08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzUwPC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdl

OXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzUzNDUwMzIiPjIzNTA8L2tleT48

L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5

cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNjaGVyZXIsIEouIFIuPC9hdXRob3I+

PGF1dGhvcj5Ld2lhdGVrLCBNLiBBLjwvYXV0aG9yPjxhdXRob3I+U29wZXIsIE4uIEouPC9hdXRo

b3I+PGF1dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+S2FocmlsYXMsIFAu

IEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0

bWVudCBvZiBNZWRpY2luZSwgRGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSwgRmVpbmJlcmcg

U2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgNjc2IE4gU3QgQ2xh

aXIgU3RyZWV0LCBTdWl0ZSAxNDAwLCBDaGljYWdvLCBJTCA2MDYxMSwgVVNBLjwvYXV0aC1hZGRy

ZXNzPjx0aXRsZXM+PHRpdGxlPkZ1bmN0aW9uYWwgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG9i

c3RydWN0aW9uIHdpdGggaW50YWN0IHBlcmlzdGFsc2lzOiBhIGhldGVyb2dlbmVvdXMgc3luZHJv

bWUgc29tZXRpbWVzIGFraW4gdG8gYWNoYWxhc2lhPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkog

R2FzdHJvaW50ZXN0IFN1cmc8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpvdXJuYWwgb2Yg

Z2FzdHJvaW50ZXN0aW5hbCBzdXJnZXJ5IDogb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgU29jaWV0

eSBmb3IgU3VyZ2VyeSBvZiB0aGUgQWxpbWVudGFyeSBUcmFjdDwvYWx0LXRpdGxlPjwvdGl0bGVz

PjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogR2FzdHJvaW50ZXN0IFN1cmc8L2Z1bGwtdGl0bGU+

PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2ludGVzdGluYWwgc3VyZ2VyeSA6IG9mZmljaWFsIGpv

dXJuYWwgb2YgdGhlIFNvY2lldHkgZm9yIFN1cmdlcnkgb2YgdGhlIEFsaW1lbnRhcnkgVHJhY3Q8

L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogR2FzdHJv

aW50ZXN0IFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2ludGVzdGlu

YWwgc3VyZ2VyeSA6IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIFNvY2lldHkgZm9yIFN1cmdlcnkg

b2YgdGhlIEFsaW1lbnRhcnkgVHJhY3Q8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4y

MjE5LTI1PC9wYWdlcz48dm9sdW1lPjEzPC92b2x1bWU+PG51bWJlcj4xMjwvbnVtYmVyPjxlZGl0

aW9uPjIwMDkvMDgvMTM8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3Jk

PjxrZXl3b3JkPkFwaGFzaWEvZXRpb2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5DaGVz

dCBQYWluL2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lhLypw

aHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9u

LypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3

b3JkPkZ1bmRvcGxpY2F0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkhlcm5pYSwgSGlhdGFsL3BoeXNp

b3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFs

ZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFn

ZWQ8L2tleXdvcmQ+PGtleXdvcmQ+KlBlcmlzdGFsc2lzPC9rZXl3b3JkPjxrZXl3b3JkPlBvc3Rv

cGVyYXRpdmUgQ29tcGxpY2F0aW9ucy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

U3luZHJvbWU8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwOTwveWVhcj48cHVi

LWRhdGVzPjxkYXRlPkRlYzwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEwOTEtMjU1

eDwvaXNibj48YWNjZXNzaW9uLW51bT4xOTY3MjY2NjwvYWNjZXNzaW9uLW51bT48dXJscz48L3Vy

bHM+PGN1c3RvbTI+UE1DMjg5MjAxMzwvY3VzdG9tMj48Y3VzdG9tNj5OSUhNUzIwOTczMzwvY3Vz

dG9tNj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTAwNy9zMTE2MDUtMDA5LTA5NzUtNzwv

ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3Jl

bW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48

L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2hlcmVyPC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48

UmVjTnVtPjIzNTA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bOV08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzUwPC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdl

OXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzUzNDUwMzIiPjIzNTA8L2tleT48

L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5

cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNjaGVyZXIsIEouIFIuPC9hdXRob3I+

PGF1dGhvcj5Ld2lhdGVrLCBNLiBBLjwvYXV0aG9yPjxhdXRob3I+U29wZXIsIE4uIEouPC9hdXRo

b3I+PGF1dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+S2FocmlsYXMsIFAu

IEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0

bWVudCBvZiBNZWRpY2luZSwgRGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSwgRmVpbmJlcmcg

U2Nob29sIG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgNjc2IE4gU3QgQ2xh

aXIgU3RyZWV0LCBTdWl0ZSAxNDAwLCBDaGljYWdvLCBJTCA2MDYxMSwgVVNBLjwvYXV0aC1hZGRy

ZXNzPjx0aXRsZXM+PHRpdGxlPkZ1bmN0aW9uYWwgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG9i

c3RydWN0aW9uIHdpdGggaW50YWN0IHBlcmlzdGFsc2lzOiBhIGhldGVyb2dlbmVvdXMgc3luZHJv

bWUgc29tZXRpbWVzIGFraW4gdG8gYWNoYWxhc2lhPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkog

R2FzdHJvaW50ZXN0IFN1cmc8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxlPkpvdXJuYWwgb2Yg

Z2FzdHJvaW50ZXN0aW5hbCBzdXJnZXJ5IDogb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgU29jaWV0

eSBmb3IgU3VyZ2VyeSBvZiB0aGUgQWxpbWVudGFyeSBUcmFjdDwvYWx0LXRpdGxlPjwvdGl0bGVz

PjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogR2FzdHJvaW50ZXN0IFN1cmc8L2Z1bGwtdGl0bGU+

PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2ludGVzdGluYWwgc3VyZ2VyeSA6IG9mZmljaWFsIGpv

dXJuYWwgb2YgdGhlIFNvY2lldHkgZm9yIFN1cmdlcnkgb2YgdGhlIEFsaW1lbnRhcnkgVHJhY3Q8

L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogR2FzdHJv

aW50ZXN0IFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2ludGVzdGlu

YWwgc3VyZ2VyeSA6IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIFNvY2lldHkgZm9yIFN1cmdlcnkg

b2YgdGhlIEFsaW1lbnRhcnkgVHJhY3Q8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4y

MjE5LTI1PC9wYWdlcz48dm9sdW1lPjEzPC92b2x1bWU+PG51bWJlcj4xMjwvbnVtYmVyPjxlZGl0

aW9uPjIwMDkvMDgvMTM8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3Jk

PjxrZXl3b3JkPkFwaGFzaWEvZXRpb2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5DaGVz

dCBQYWluL2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lhLypw

aHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9u

LypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3

b3JkPkZ1bmRvcGxpY2F0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPkhlcm5pYSwgSGlhdGFsL3BoeXNp

b3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFs

ZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFn

ZWQ8L2tleXdvcmQ+PGtleXdvcmQ+KlBlcmlzdGFsc2lzPC9rZXl3b3JkPjxrZXl3b3JkPlBvc3Rv

cGVyYXRpdmUgQ29tcGxpY2F0aW9ucy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

U3luZHJvbWU8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwOTwveWVhcj48cHVi

LWRhdGVzPjxkYXRlPkRlYzwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEwOTEtMjU1

eDwvaXNibj48YWNjZXNzaW9uLW51bT4xOTY3MjY2NjwvYWNjZXNzaW9uLW51bT48dXJscz48L3Vy

bHM+PGN1c3RvbTI+UE1DMjg5MjAxMzwvY3VzdG9tMj48Y3VzdG9tNj5OSUhNUzIwOTczMzwvY3Vz

dG9tNj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTAwNy9zMTE2MDUtMDA5LTA5NzUtNzwv

ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3Jl

bW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48

L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE.DATA [9]. An IRP cut-off value of 20 mmHg using Sandhill HRM system and compartmentalized pressurization has been shown to segregate clinically relevant from clinically not-relevant EGJOO. It has also been shown that presence of chest pain with dysphagia increase the likelihood of symptoms persistence and progression to achalasia in EGJOOPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb25nPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48UmVj

TnVtPjIzNjI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij5b

MTBdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM2MjwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM3NjcwNzkwIj4yMzYyPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Tb25nLCBCLiBHLjwvYXV0aG9yPjxhdXRo

b3I+TWluLCBZLiBXLjwvYXV0aG9yPjxhdXRob3I+TGVlLCBILjwvYXV0aG9yPjxhdXRob3I+TWlu

LCBCLiBILjwvYXV0aG9yPjxhdXRob3I+TGVlLCBKLiBILjwvYXV0aG9yPjxhdXRob3I+UmhlZSwg

UC4gTC48L2F1dGhvcj48YXV0aG9yPktpbSwgSi4gSi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250

cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBTYW1zdW5nIE1l

ZGljYWwgQ2VudGVyLCBTdW5na3l1bmt3YW4gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUs

IFNlb3VsLCBLb3JlYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5DbGluaWNvbWFub21l

dHJpYyBmYWN0b3JzIGFzc29jaWF0ZWQgd2l0aCBjbGluaWNhbGx5IHJlbGV2YW50IGVzb3BoYWdv

Z2FzdHJpYyBqdW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uIGZyb20gdGhlIFNhbmRoaWxsIGhp

Z2gtcmVzb2x1dGlvbiBtYW5vbWV0cnkgc3lzdGVtPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5l

dXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9n

YXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRo

ZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48

L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8

L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDog

dGhlIG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90

aWxpdHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9n

YXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRo

ZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2Fs

dC1wZXJpb2RpY2FsPjx2b2x1bWU+MzA8L3ZvbHVtZT48bnVtYmVyPjM8L251bWJlcj48ZWRpdGlv

bj4yMDE3LzEwLzEzPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5TYW5kaGlsbDwva2V5d29y

ZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0cnVjdGlvbjwv

a2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24gbWFub21ldHJ5IHN5c3RlbTwva2V5d29y

ZD48a2V5d29yZD5pbnRlZ3JhdGVkIHJlbGF4YXRpb24gcHJlc3N1cmU8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAxODwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1hcjwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4y

OTAyNDMxNDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjEwLjExMTEvbm1vLjEzMjIxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRh

dGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5l

bmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb25nPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48UmVj

TnVtPjIzNjI8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij5b

MTBdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM2MjwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM3NjcwNzkwIj4yMzYyPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Tb25nLCBCLiBHLjwvYXV0aG9yPjxhdXRo

b3I+TWluLCBZLiBXLjwvYXV0aG9yPjxhdXRob3I+TGVlLCBILjwvYXV0aG9yPjxhdXRob3I+TWlu

LCBCLiBILjwvYXV0aG9yPjxhdXRob3I+TGVlLCBKLiBILjwvYXV0aG9yPjxhdXRob3I+UmhlZSwg

UC4gTC48L2F1dGhvcj48YXV0aG9yPktpbSwgSi4gSi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250

cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBTYW1zdW5nIE1l

ZGljYWwgQ2VudGVyLCBTdW5na3l1bmt3YW4gVW5pdmVyc2l0eSBTY2hvb2wgb2YgTWVkaWNpbmUs

IFNlb3VsLCBLb3JlYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5DbGluaWNvbWFub21l

dHJpYyBmYWN0b3JzIGFzc29jaWF0ZWQgd2l0aCBjbGluaWNhbGx5IHJlbGV2YW50IGVzb3BoYWdv

Z2FzdHJpYyBqdW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uIGZyb20gdGhlIFNhbmRoaWxsIGhp

Z2gtcmVzb2x1dGlvbiBtYW5vbWV0cnkgc3lzdGVtPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5l

dXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9n

YXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRo

ZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48

L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8

L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDog

dGhlIG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90

aWxpdHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9n

YXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRo

ZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2Fs

dC1wZXJpb2RpY2FsPjx2b2x1bWU+MzA8L3ZvbHVtZT48bnVtYmVyPjM8L251bWJlcj48ZWRpdGlv

bj4yMDE3LzEwLzEzPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5TYW5kaGlsbDwva2V5d29y

ZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0cnVjdGlvbjwv

a2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24gbWFub21ldHJ5IHN5c3RlbTwva2V5d29y

ZD48a2V5d29yZD5pbnRlZ3JhdGVkIHJlbGF4YXRpb24gcHJlc3N1cmU8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAxODwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1hcjwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4y

OTAyNDMxNDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjEwLjExMTEvbm1vLjEzMjIxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRh

dGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5l

bmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA [10]. An upright IRP > 12 mmHg (using Sierra HRM system) has been demonstrated to be sensitive, although not specific, to detect EGJOO identified on timed barium esophagram (TBE) or present with dysphagia ADDIN EN.CITE <EndNote><Cite><Author>Triggs</Author><Year>2018</Year><RecNum>137</RecNum><DisplayText><style face="superscript">[11]</style></DisplayText><record><rec-number>137</rec-number><foreign-keys><key app="EN" db-id="t9de09x5aa90v7eptstvd0aofpax5axsrffa" timestamp="1537726922">137</key></foreign-keys><ref-type name="Conference Paper">47</ref-type><contributors><authors><author>Triggs, J, Carlson, D, Beveridge, C, Jain, A, Tye, MY, Kahrilas, PJ, Pandolfino, JE</author></authors></contributors><titles><title>UPRIGHT INTEGRATED RELAXATION PRESSURE FACILITATES CHARACTERIZATION OF ESOPHAGOGASTRIC JUNCTION OUTLET OBSTRUCTION</title><secondary-title>DDW</secondary-title></titles><volume>Mo1506</volume><dates><year>2018</year></dates><work-type>Abstract</work-type><urls></urls></record></Cite></EndNote>[11].In addition to endoscopy and HRM, other ancillary tests such as TBE, functional luminal imaging probe (FLIP), endoscopic ultrasound (EUS), and computed tomography (CT) scan can further elucidate the obstruction at the EGJ and point to a certain etiology ADDIN EN.CITE <EndNote><Cite><Author>Carlson</Author><Year>2018</Year><RecNum>2344</RecNum><DisplayText><style face="superscript">[12]</style></DisplayText><record><rec-number>2344</rec-number><foreign-keys><key app="EN" db-id="50wxdpzd9vd5r7e9t5b595djrfpttrxw9avp" timestamp="1534193236">2344</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carlson, D. A.</author><author>Gyawali, C. P.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.&#xD;Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: cprakash@wustl.edu.</auth-address><titles><title>Is High-Resolution Manometry Always Needed for the Diagnosis of Achalasia?</title><secondary-title>Clin Gastroenterol Hepatol</secondary-title><alt-title>Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association</alt-title></titles><periodical><full-title>Clin Gastroenterol Hepatol</full-title><abbr-1>Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association</abbr-1></periodical><alt-periodical><full-title>Clin Gastroenterol Hepatol</full-title><abbr-1>Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association</abbr-1></alt-periodical><pages>480-482</pages><volume>16</volume><number>4</number><edition>2017/10/11</edition><dates><year>2018</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>28987504</accession-num><urls></urls><electronic-resource-num>10.1016/j.cgh.2017.06.019</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[12]. The TBE is a simple test to perform with low radiation exposure. The patient drinks 100-200 ml of low-density barium sulfate in the upright position. Frontal X-ray images are obtained at 1, 2 and 5 minPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZSBPbGl2ZWlyYTwvQXV0aG9yPjxZZWFyPjE5OTc8L1ll

YXI+PFJlY051bT4yMzQ4PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNj

cmlwdCI+WzEzXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNDg8

L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2

ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTUzNTAwNDU3NSI+MjM0ODwv

a2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9y

ZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+ZGUgT2xpdmVpcmEsIEouIE0u

PC9hdXRob3I+PGF1dGhvcj5CaXJnaXNzb24sIFMuPC9hdXRob3I+PGF1dGhvcj5Eb2lub2ZmLCBD

LjwvYXV0aG9yPjxhdXRob3I+RWluc3RlaW4sIEQuPC9hdXRob3I+PGF1dGhvcj5IZXJ0cywgQi48

L2F1dGhvcj48YXV0aG9yPkRhdnJvcywgVy48L2F1dGhvcj48YXV0aG9yPk9idWNob3dza2ksIE4u

PC9hdXRob3I+PGF1dGhvcj5Lb2VobGVyLCBSLiBFLjwvYXV0aG9yPjxhdXRob3I+UmljaHRlciwg

Si48L2F1dGhvcj48YXV0aG9yPkJha2VyLCBNLiBFLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRy

aWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIFJhZGlvbG9neSwgQ2xldmVsYW5kIENs

aW5pYyBGb3VuZGF0aW9uLCBPSCA0NDE5NSwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRp

dGxlPlRpbWVkIGJhcml1bSBzd2FsbG93OiBhIHNpbXBsZSB0ZWNobmlxdWUgZm9yIGV2YWx1YXRp

bmcgZXNvcGhhZ2VhbCBlbXB0eWluZyBpbiBwYXRpZW50cyB3aXRoIGFjaGFsYXNpYTwvdGl0bGU+

PHNlY29uZGFyeS10aXRsZT5BSlIgQW0gSiBSb2VudGdlbm9sPC9zZWNvbmRhcnktdGl0bGU+PGFs

dC10aXRsZT5BSlIuIEFtZXJpY2FuIGpvdXJuYWwgb2Ygcm9lbnRnZW5vbG9neTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFKUiBBbSBKIFJvZW50Z2Vub2w8L2Z1

bGwtdGl0bGU+PGFiYnItMT5BSlIuIEFtZXJpY2FuIGpvdXJuYWwgb2Ygcm9lbnRnZW5vbG9neTwv

YWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QUpSIEFtIEog

Um9lbnRnZW5vbDwvZnVsbC10aXRsZT48YWJici0xPkFKUi4gQW1lcmljYW4gam91cm5hbCBvZiBy

b2VudGdlbm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NDczLTk8L3BhZ2Vz

Pjx2b2x1bWU+MTY5PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MTk5Ny8wOC8w

MTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5d29y

ZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPipCYXJpdW0g

U3VsZmF0ZS9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2U8L2tleXdvcmQ+PGtleXdvcmQ+Q29u

dHJhc3QgTWVkaWEvKmFkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZTwva2V5d29yZD48a2V5d29y

ZD5EZWdsdXRpdGlvbjwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIEFjaGFsYXNpYS8qZGlh

Z25vc3RpYyBpbWFnaW5nL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFn

dXMvKmRpYWdub3N0aWMgaW1hZ2luZy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lz

PC9rZXl3b3JkPjxrZXl3b3JkPlJhZGlvZ3JhcGh5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVz

Pjx5ZWFyPjE5OTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+

PC9kYXRlcz48aXNibj4wMzYxLTgwM1ggKFByaW50KSYjeEQ7MDM2MS04MDN4PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjkyNDI3NTY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4yMjE0L2Fqci4xNjkuMi45MjQyNzU2PC9lbGVjdHJvbmljLXJlc291

cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXBy

b3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5kZSBPbGl2ZWlyYTwvQXV0aG9yPjxZZWFyPjE5OTc8L1ll

YXI+PFJlY051bT4yMzQ4PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNj

cmlwdCI+WzEzXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNDg8

L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2

ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTUzNTAwNDU3NSI+MjM0ODwv

a2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9y

ZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+ZGUgT2xpdmVpcmEsIEouIE0u

PC9hdXRob3I+PGF1dGhvcj5CaXJnaXNzb24sIFMuPC9hdXRob3I+PGF1dGhvcj5Eb2lub2ZmLCBD

LjwvYXV0aG9yPjxhdXRob3I+RWluc3RlaW4sIEQuPC9hdXRob3I+PGF1dGhvcj5IZXJ0cywgQi48

L2F1dGhvcj48YXV0aG9yPkRhdnJvcywgVy48L2F1dGhvcj48YXV0aG9yPk9idWNob3dza2ksIE4u

PC9hdXRob3I+PGF1dGhvcj5Lb2VobGVyLCBSLiBFLjwvYXV0aG9yPjxhdXRob3I+UmljaHRlciwg

Si48L2F1dGhvcj48YXV0aG9yPkJha2VyLCBNLiBFLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRy

aWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIFJhZGlvbG9neSwgQ2xldmVsYW5kIENs

aW5pYyBGb3VuZGF0aW9uLCBPSCA0NDE5NSwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRp

dGxlPlRpbWVkIGJhcml1bSBzd2FsbG93OiBhIHNpbXBsZSB0ZWNobmlxdWUgZm9yIGV2YWx1YXRp

bmcgZXNvcGhhZ2VhbCBlbXB0eWluZyBpbiBwYXRpZW50cyB3aXRoIGFjaGFsYXNpYTwvdGl0bGU+

PHNlY29uZGFyeS10aXRsZT5BSlIgQW0gSiBSb2VudGdlbm9sPC9zZWNvbmRhcnktdGl0bGU+PGFs

dC10aXRsZT5BSlIuIEFtZXJpY2FuIGpvdXJuYWwgb2Ygcm9lbnRnZW5vbG9neTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFKUiBBbSBKIFJvZW50Z2Vub2w8L2Z1

bGwtdGl0bGU+PGFiYnItMT5BSlIuIEFtZXJpY2FuIGpvdXJuYWwgb2Ygcm9lbnRnZW5vbG9neTwv

YWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+QUpSIEFtIEog

Um9lbnRnZW5vbDwvZnVsbC10aXRsZT48YWJici0xPkFKUi4gQW1lcmljYW4gam91cm5hbCBvZiBy

b2VudGdlbm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NDczLTk8L3BhZ2Vz

Pjx2b2x1bWU+MTY5PC92b2x1bWU+PG51bWJlcj4yPC9udW1iZXI+PGVkaXRpb24+MTk5Ny8wOC8w

MTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29yZD48a2V5d29y

ZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPipCYXJpdW0g

U3VsZmF0ZS9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2U8L2tleXdvcmQ+PGtleXdvcmQ+Q29u

dHJhc3QgTWVkaWEvKmFkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZTwva2V5d29yZD48a2V5d29y

ZD5EZWdsdXRpdGlvbjwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIEFjaGFsYXNpYS8qZGlh

Z25vc3RpYyBpbWFnaW5nL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFn

dXMvKmRpYWdub3N0aWMgaW1hZ2luZy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lz

PC9rZXl3b3JkPjxrZXl3b3JkPlJhZGlvZ3JhcGh5PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVz

Pjx5ZWFyPjE5OTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+

PC9kYXRlcz48aXNibj4wMzYxLTgwM1ggKFByaW50KSYjeEQ7MDM2MS04MDN4PC9pc2JuPjxhY2Nl

c3Npb24tbnVtPjkyNDI3NTY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxlbGVjdHJvbmlj

LXJlc291cmNlLW51bT4xMC4yMjE0L2Fqci4xNjkuMi45MjQyNzU2PC9lbGVjdHJvbmljLXJlc291

cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXBy

b3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [13]. TBE has been shown to have its greatest value in differentiating non-treated achalasia from EGJOO/non-achalasia dysphagia. It was shown in a recent study with the barium height of 5 cm at 1 minute to have an excellent accuracy with a sensitivity of 94% and specificity of 71% (AUC = 0.915; 95% CI 0.883-0.946; P < 0.0001) in differentiating non-treated achalasia from EGJOO and non-achalasia dysphagia. The diagnostic yield increased to 100% in non-treated achalasia and 60% in EGJOO when 13-mm barium tablet was added to the liquid TBE ADDIN EN.CITE <EndNote><Cite><Author>Blonski</Author><Year>2018</Year><RecNum>2343</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>2343</rec-number><foreign-keys><key app="EN" db-id="50wxdpzd9vd5r7e9t5b595djrfpttrxw9avp" timestamp="1534190177">2343</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Blonski, W.</author><author>Kumar, A.</author><author>Feldman, J.</author><author>Richter, J. E.</author></authors></contributors><auth-address>Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Division of Evidence Based Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.</auth-address><titles><title>Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>196-203</pages><volume>113</volume><number>2</number><edition>2017/12/20</edition><dates><year>2018</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>29257145</accession-num><urls></urls><electronic-resource-num>10.1038/ajg.2017.370</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[14]. Therefore, abnormal TBE with barium tablet retention is an excellent surrogate to diagnose achalasia when HRM is intolerable, not available, or of poor quality. However, it does not eliminate the need for HRM in cases of EGJOO due to poor accuracy of liquid barium to differentiate EGJOO from non-achalasia dysphagia ADDIN EN.CITE <EndNote><Cite><Author>Blonski</Author><Year>2018</Year><RecNum>2343</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>2343</rec-number><foreign-keys><key app="EN" db-id="50wxdpzd9vd5r7e9t5b595djrfpttrxw9avp" timestamp="1534190177">2343</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Blonski, W.</author><author>Kumar, A.</author><author>Feldman, J.</author><author>Richter, J. E.</author></authors></contributors><auth-address>Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Division of Evidence Based Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.</auth-address><titles><title>Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>196-203</pages><volume>113</volume><number>2</number><edition>2017/12/20</edition><dates><year>2018</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>29257145</accession-num><urls></urls><electronic-resource-num>10.1038/ajg.2017.370</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[14]. It is proposed that cutoff values of barium column height ( 5 cm at 1 min and 2 cm at 5 min) to separate untreated achalasia from EGJOO and non-achalasia dysphagia ADDIN EN.CITE <EndNote><Cite><Author>Blonski</Author><Year>2018</Year><RecNum>2343</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>2343</rec-number><foreign-keys><key app="EN" db-id="50wxdpzd9vd5r7e9t5b595djrfpttrxw9avp" timestamp="1534190177">2343</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Blonski, W.</author><author>Kumar, A.</author><author>Feldman, J.</author><author>Richter, J. E.</author></authors></contributors><auth-address>Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Division of Evidence Based Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.&#xD;Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.</auth-address><titles><title>Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>196-203</pages><volume>113</volume><number>2</number><edition>2017/12/20</edition><dates><year>2018</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>29257145</accession-num><urls></urls><electronic-resource-num>10.1038/ajg.2017.370</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[14].Another diagnostic test which has not made its way widely to the clinical arena yet is the functional luminal imaging probe (FLIP) technology. FLIP measures the cross-sectional area of the esophagus during volume-controlled distension (balloon catheter filled with liquid) which then leads to a software-created high-resolution impedance planimetry with simultaneous measurement of pressure and diameter of the esophagus. This technique assesses the opening dynamics at the EGJ, in addition to esophageal wall stiffness and compliancePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXJsc29uPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48

UmVjTnVtPjIzNDc8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bMTVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0NzwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM0MzU5OTcxIj4yMzQ3PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DYXJsc29uLCBELiBBLjwvYXV0aG9y

PjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PGF1dGhvcj5MaW4sIFouPC9hdXRob3I+

PGF1dGhvcj5IaXJhbm8sIEkuPC9hdXRob3I+PGF1dGhvcj5Hb25zYWx2ZXMsIE4uPC9hdXRob3I+

PGF1dGhvcj5MaXN0ZXJuaWNrLCBaLjwvYXV0aG9yPjxhdXRob3I+Uml0dGVyLCBLLjwvYXV0aG9y

PjxhdXRob3I+VHllLCBNLjwvYXV0aG9yPjxhdXRob3I+UG9uZHMsIEYuIEEuPC9hdXRob3I+PGF1

dGhvcj5Xb25nLCBJLjwvYXV0aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48

L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGlj

aW5lLCBEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBGZWluYmVy

ZyBTY2hvb2wgb2YgTWVkaWNpbmUsIE5vcnRod2VzdGVybiBVbml2ZXJzaXR5LCBDaGljYWdvLCBJ

bGxpbm9pcywgVVNBLiYjeEQ7RGVwYXJ0bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBh

dG9sb2d5LCBBY2FkZW1pYyBNZWRpY2FsIENlbnRlciwgVW5pdmVyc2l0eSBvZiBBbXN0ZXJkYW0s

IEFtc3RlcmRhbSwgVGhlIE5ldGhlcmxhbmRzLiYjeEQ7RGVwYXJ0bWVudCBvZiBTdXJnZXJ5LCBU

aGUgVW5pdmVyc2l0eSBvZiBIb25nIEtvbmcsIEhvbmcgS29uZyBTQVIsIENoaW5hLjwvYXV0aC1h

ZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkV2YWx1YXRpb24gb2YgRXNvcGhhZ2VhbCBNb3RpbGl0eSBV

dGlsaXppbmcgdGhlIEZ1bmN0aW9uYWwgTHVtZW4gSW1hZ2luZyBQcm9iZTwvdGl0bGU+PHNlY29u

ZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxl

PlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0

bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJy

LTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2Vu

dGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9l

bnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTcyNi0xNzM1PC9wYWdl

cz48dm9sdW1lPjExMTwvdm9sdW1lPjxudW1iZXI+MTI8L251bWJlcj48ZWRpdGlvbj4yMDE2LzEw

LzEyPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZG9sZXNjZW50PC9rZXl3b3JkPjxrZXl3

b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZCwg

ODAgYW5kIG92ZXI8L2tleXdvcmQ+PGtleXdvcmQ+RGVnbHV0aXRpb24gRGlzb3JkZXJzLypkaWFn

bm9zdGljIGltYWdpbmcvcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVsZWN0cmlj

IEltcGVkYW5jZTwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHksIERpZ2VzdGl2ZSBTeXN0ZW08

L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvKmRpYWdub3N0aWMgaW1hZ2lu

Zy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBNb3RpbGl0eSBE

aXNvcmRlcnMvZGlhZ25vc3RpYyBpbWFnaW5nL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5

d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vKmRpYWdub3N0aWMgaW1hZ2luZy9waHlzaW9w

YXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ3VzLypkaWFnbm9zdGljIGltYWdpbmcv

cGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29y

ZD4qR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl

eXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+

PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXVzY2xlIENvbnRyYWN0aW9u

PC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lzPC9rZXl3b3JkPjxrZXl3b3JkPllvdW5nIEFk

dWx0PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5EZWM8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjc3MjU2NTA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxj

dXN0b20yPlBNQzUyMjQ1Mjg8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM4MzU5Njg8L2N1c3RvbTY+

PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMzgvYWpnLjIwMTYuNDU0PC9lbGVjdHJvbmlj

LXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0Vu

ZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXJsc29uPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48

UmVjTnVtPjIzNDc8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bMTVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0NzwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM0MzU5OTcxIj4yMzQ3PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DYXJsc29uLCBELiBBLjwvYXV0aG9y

PjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PGF1dGhvcj5MaW4sIFouPC9hdXRob3I+

PGF1dGhvcj5IaXJhbm8sIEkuPC9hdXRob3I+PGF1dGhvcj5Hb25zYWx2ZXMsIE4uPC9hdXRob3I+

PGF1dGhvcj5MaXN0ZXJuaWNrLCBaLjwvYXV0aG9yPjxhdXRob3I+Uml0dGVyLCBLLjwvYXV0aG9y

PjxhdXRob3I+VHllLCBNLjwvYXV0aG9yPjxhdXRob3I+UG9uZHMsIEYuIEEuPC9hdXRob3I+PGF1

dGhvcj5Xb25nLCBJLjwvYXV0aG9yPjxhdXRob3I+UGFuZG9sZmlubywgSi4gRS48L2F1dGhvcj48

L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIE1lZGlj

aW5lLCBEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBGZWluYmVy

ZyBTY2hvb2wgb2YgTWVkaWNpbmUsIE5vcnRod2VzdGVybiBVbml2ZXJzaXR5LCBDaGljYWdvLCBJ

bGxpbm9pcywgVVNBLiYjeEQ7RGVwYXJ0bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBh

dG9sb2d5LCBBY2FkZW1pYyBNZWRpY2FsIENlbnRlciwgVW5pdmVyc2l0eSBvZiBBbXN0ZXJkYW0s

IEFtc3RlcmRhbSwgVGhlIE5ldGhlcmxhbmRzLiYjeEQ7RGVwYXJ0bWVudCBvZiBTdXJnZXJ5LCBU

aGUgVW5pdmVyc2l0eSBvZiBIb25nIEtvbmcsIEhvbmcgS29uZyBTQVIsIENoaW5hLjwvYXV0aC1h

ZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkV2YWx1YXRpb24gb2YgRXNvcGhhZ2VhbCBNb3RpbGl0eSBV

dGlsaXppbmcgdGhlIEZ1bmN0aW9uYWwgTHVtZW4gSW1hZ2luZyBQcm9iZTwvdGl0bGU+PHNlY29u

ZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxl

PlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0

bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJy

LTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2Vu

dGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBvZiBnYXN0cm9l

bnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTcyNi0xNzM1PC9wYWdl

cz48dm9sdW1lPjExMTwvdm9sdW1lPjxudW1iZXI+MTI8L251bWJlcj48ZWRpdGlvbj4yMDE2LzEw

LzEyPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZG9sZXNjZW50PC9rZXl3b3JkPjxrZXl3

b3JkPkFkdWx0PC9rZXl3b3JkPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZCwg

ODAgYW5kIG92ZXI8L2tleXdvcmQ+PGtleXdvcmQ+RGVnbHV0aXRpb24gRGlzb3JkZXJzLypkaWFn

bm9zdGljIGltYWdpbmcvcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVsZWN0cmlj

IEltcGVkYW5jZTwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHksIERpZ2VzdGl2ZSBTeXN0ZW08

L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvKmRpYWdub3N0aWMgaW1hZ2lu

Zy9waHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBNb3RpbGl0eSBE

aXNvcmRlcnMvZGlhZ25vc3RpYyBpbWFnaW5nL3BoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5

d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vKmRpYWdub3N0aWMgaW1hZ2luZy9waHlzaW9w

YXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ3VzLypkaWFnbm9zdGljIGltYWdpbmcv

cGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29y

ZD4qR2FzdHJvaW50ZXN0aW5hbCBNb3RpbGl0eTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tl

eXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+

PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXVzY2xlIENvbnRyYWN0aW9u

PC9rZXl3b3JkPjxrZXl3b3JkPlBlcmlzdGFsc2lzPC9rZXl3b3JkPjxrZXl3b3JkPllvdW5nIEFk

dWx0PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5EZWM8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjc3MjU2NTA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxj

dXN0b20yPlBNQzUyMjQ1Mjg8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM4MzU5Njg8L2N1c3RvbTY+

PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMzgvYWpnLjIwMTYuNDU0PC9lbGVjdHJvbmlj

LXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0Vu

ZE5vdGU+AG==

ADDIN EN.CITE.DATA [15]. However, this technology is not widely available and is limited to esophageal centers of excellence as an exploratory method with data mostly focused on assessment and outcomes in achalasia and EoEPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS

ZWNOdW0+MjM0NjwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxNl08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzQ2PC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdl

OXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzQzNDM3NDIiPjIzNDY8L2tleT48

L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5

cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhpcmFubywgSS48L2F1dGhvcj48YXV0

aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRob3I+PGF1dGhvcj5Cb2Vja3hzdGFlbnMsIEcuIEUu

PC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVu

dCBvZiBNZWRpY2luZSwgRGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9n

eSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBD

aGljYWdvLCBJbGxpbm9pcy4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwgVHJh

bnNsYXRpb25hbCBSZXNlYXJjaCBDZW50ZXIgZm9yIEdhc3Ryb2ludGVzdGluYWwgRGlzb3JkZXJz

LCBVbml2ZXJzaXR5IEhvc3BpdGFsIExldXZlbiwgQ2F0aG9saWMgVW5pdmVyc2l0eSBvZiBMZXV2

ZW4sIExldXZlbiwgQmVsZ2l1bS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5GdW5jdGlv

bmFsIEx1bWVuIEltYWdpbmcgUHJvYmUgZm9yIHRoZSBNYW5hZ2VtZW50IG9mIEVzb3BoYWdlYWwg

RGlzb3JkZXJzOiBFeHBlcnQgUmV2aWV3IEZyb20gdGhlIENsaW5pY2FsIFByYWN0aWNlIFVwZGF0

ZXMgQ29tbWl0dGVlIG9mIHRoZSBBR0EgSW5zdGl0dXRlPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxl

PkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5D

bGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNs

aW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2lj

YWwgQXNzb2NpYXRpb248L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvZnVsbC10aXRsZT48YWJici0xPkNsaW5pY2Fs

IGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwg

cHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1lcmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3Nv

Y2lhdGlvbjwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBn

YXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHBy

YWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2Np

YXRpb248L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4zMjUtMzM0PC9wYWdlcz48dm9s

dW1lPjE1PC92b2x1bWU+PG51bWJlcj4zPC9udW1iZXI+PGVkaXRpb24+MjAxNy8wMi8xOTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBEaXNlYXNlcy8qZGlhZ25vc3RpYyBp

bWFnaW5nPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5PcHRpY2Fs

IEltYWdpbmcvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJhY3RpY2UgR3VpZGVsaW5lcyBh

cyBUb3BpYzwva2V5d29yZD48a2V5d29yZD5BY2hhbGFzaWE8L2tleXdvcmQ+PGtleXdvcmQ+RW9z

aW5vcGhpbGljIEVzb3BoYWdpdGlzPC9rZXl3b3JkPjxrZXl3b3JkPkZ1bmN0aW9uYWwgTHVtZW4g

SW1hZ2luZyBQcm9iZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eCBE

aXNlYXNlPC9rZXl3b3JkPjxrZXl3b3JkPkltcGVkYW5jZSBQbGFuaW1ldHJ5PC9rZXl3b3JkPjwv

a2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXI8L2Rh

dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTQyLTM1NjU8L2lzYm4+PGFjY2Vzc2lvbi1u

dW0+MjgyMTI5NzY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzU3NTc1

MDc8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTI5NjQ8L2N1c3RvbTY+PGVsZWN0cm9uaWMtcmVz

b3VyY2UtbnVtPjEwLjEwMTYvai5jZ2guMjAxNi4xMC4wMjI8L2VsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlk

ZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXJhbm88L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS

ZWNOdW0+MjM0NjwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsxNl08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzQ2PC9yZWMt

bnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdl

OXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzQzNDM3NDIiPjIzNDY8L2tleT48

L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5

cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhpcmFubywgSS48L2F1dGhvcj48YXV0

aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRob3I+PGF1dGhvcj5Cb2Vja3hzdGFlbnMsIEcuIEUu

PC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVu

dCBvZiBNZWRpY2luZSwgRGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9n

eSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBD

aGljYWdvLCBJbGxpbm9pcy4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwgVHJh

bnNsYXRpb25hbCBSZXNlYXJjaCBDZW50ZXIgZm9yIEdhc3Ryb2ludGVzdGluYWwgRGlzb3JkZXJz

LCBVbml2ZXJzaXR5IEhvc3BpdGFsIExldXZlbiwgQ2F0aG9saWMgVW5pdmVyc2l0eSBvZiBMZXV2

ZW4sIExldXZlbiwgQmVsZ2l1bS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5GdW5jdGlv

bmFsIEx1bWVuIEltYWdpbmcgUHJvYmUgZm9yIHRoZSBNYW5hZ2VtZW50IG9mIEVzb3BoYWdlYWwg

RGlzb3JkZXJzOiBFeHBlcnQgUmV2aWV3IEZyb20gdGhlIENsaW5pY2FsIFByYWN0aWNlIFVwZGF0

ZXMgQ29tbWl0dGVlIG9mIHRoZSBBR0EgSW5zdGl0dXRlPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxl

PkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5D

bGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNs

aW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2lj

YWwgQXNzb2NpYXRpb248L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRs

ZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvZnVsbC10aXRsZT48YWJici0xPkNsaW5pY2Fs

IGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwg

cHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1lcmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3Nv

Y2lhdGlvbjwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBn

YXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHBy

YWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2Np

YXRpb248L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4zMjUtMzM0PC9wYWdlcz48dm9s

dW1lPjE1PC92b2x1bWU+PG51bWJlcj4zPC9udW1iZXI+PGVkaXRpb24+MjAxNy8wMi8xOTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBEaXNlYXNlcy8qZGlhZ25vc3RpYyBp

bWFnaW5nPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5PcHRpY2Fs

IEltYWdpbmcvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJhY3RpY2UgR3VpZGVsaW5lcyBh

cyBUb3BpYzwva2V5d29yZD48a2V5d29yZD5BY2hhbGFzaWE8L2tleXdvcmQ+PGtleXdvcmQ+RW9z

aW5vcGhpbGljIEVzb3BoYWdpdGlzPC9rZXl3b3JkPjxrZXl3b3JkPkZ1bmN0aW9uYWwgTHVtZW4g

SW1hZ2luZyBQcm9iZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eCBE

aXNlYXNlPC9rZXl3b3JkPjxrZXl3b3JkPkltcGVkYW5jZSBQbGFuaW1ldHJ5PC9rZXl3b3JkPjwv

a2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXI8L2Rh

dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xNTQyLTM1NjU8L2lzYm4+PGFjY2Vzc2lvbi1u

dW0+MjgyMTI5NzY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzU3NTc1

MDc8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTI5NjQ8L2N1c3RvbTY+PGVsZWN0cm9uaWMtcmVz

b3VyY2UtbnVtPjEwLjEwMTYvai5jZ2guMjAxNi4xMC4wMjI8L2VsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlk

ZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE.DATA [16].In most cases, a mechanical cause of obstruction at the GE junction can be detected by performing endoscopy and cross-sectional imaging studiesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pa2VrZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl

Y051bT4yMzQxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MTwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzOTM4NzQ5Ij4yMzQxPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Pa2VrZSwgRi4gQy48L2F1dGhvcj48YXV0

aG9yPlJhamEsIFMuPC9hdXRob3I+PGF1dGhvcj5MeW5jaCwgSy4gTC48L2F1dGhvcj48YXV0aG9y

PkRoYWxsYSwgUy48L2F1dGhvcj48YXV0aG9yPk5hbmR3YW5pLCBNLjwvYXV0aG9yPjxhdXRob3I+

U3RlaW4sIEUuIE0uPC9hdXRob3I+PGF1dGhvcj5DaGFuZGVyIFJvbGFuZCwgQi48L2F1dGhvcj48

YXV0aG9yPktoYXNoYWIsIE0uIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkFodWphLCBOLiBLLjwvYXV0aG9y

PjxhdXRob3I+Q2xhcmtlLCBKLiBPLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEhvc3BpdGFsIE1lZGljaW5lLCBUaGUgSm9obnMgSG9w

a2lucyBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYj

eEQ7RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBFbW9yeSBV

bml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EsIFVTQS4mI3hEO0Rpdmlz

aW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgVW5pdmVyc2l0eSBvZiBQ

ZW5uc3lsdmFuaWEgU2Nob29sIG9mIE1lZGljaW5lLCBQaGlsYWRlbHBoaWEsIFBBLCBVU0EuJiN4

RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFRoZSBKb2hu

cyBIb3BraW5zIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1ELCBV

U0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFN0

YW5mb3JkIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdGFuZm9yZCwgQ0EsIFVTQS4m

I3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIFJveWFsIFByaW5jZSBBbGZyZWQgSG9z

cGl0YWwsIFN5ZG5leSwgTlNXLCBBdXN0cmFsaWEuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0

bGU+V2hhdCBpcyB0aGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBq

dW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uPyBldmFsdWF0aW9uIG9mIDYwIHBhdGllbnRzIGF0

IGEgdGVydGlhcnkgcmVmZXJyYWwgY2VudGVyPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJv

Z2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1

bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhl

IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxp

dHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0

bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1w

ZXJpb2RpY2FsPjx2b2x1bWU+Mjk8L3ZvbHVtZT48bnVtYmVyPjY8L251bWJlcj48ZWRpdGlvbj4y

MDE3LzA0LzExPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3

b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFz

ZXMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzL3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ29nYXN0cmljIEp1bmN0aW9uLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlRlcnRpYXJ5IENh

cmUgQ2VudGVyczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48

a2V5d29yZD5keXNwaGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gKEVHSk9PKTwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24g

ZXNvcGhhZ2VhbCBwcmVzc3VyZSB0b3BvZ3JhcGh5IChIUkVQVCk8L2tleXdvcmQ+PC9rZXl3b3Jk

cz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1

Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yODM5

MzQzNzwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjExMTEvbm1vLjEzMDYxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8

L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pa2VrZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl

Y051bT4yMzQxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MTwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzOTM4NzQ5Ij4yMzQxPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Pa2VrZSwgRi4gQy48L2F1dGhvcj48YXV0

aG9yPlJhamEsIFMuPC9hdXRob3I+PGF1dGhvcj5MeW5jaCwgSy4gTC48L2F1dGhvcj48YXV0aG9y

PkRoYWxsYSwgUy48L2F1dGhvcj48YXV0aG9yPk5hbmR3YW5pLCBNLjwvYXV0aG9yPjxhdXRob3I+

U3RlaW4sIEUuIE0uPC9hdXRob3I+PGF1dGhvcj5DaGFuZGVyIFJvbGFuZCwgQi48L2F1dGhvcj48

YXV0aG9yPktoYXNoYWIsIE0uIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkFodWphLCBOLiBLLjwvYXV0aG9y

PjxhdXRob3I+Q2xhcmtlLCBKLiBPLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEhvc3BpdGFsIE1lZGljaW5lLCBUaGUgSm9obnMgSG9w

a2lucyBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYj

eEQ7RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBFbW9yeSBV

bml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EsIFVTQS4mI3hEO0Rpdmlz

aW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgVW5pdmVyc2l0eSBvZiBQ

ZW5uc3lsdmFuaWEgU2Nob29sIG9mIE1lZGljaW5lLCBQaGlsYWRlbHBoaWEsIFBBLCBVU0EuJiN4

RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFRoZSBKb2hu

cyBIb3BraW5zIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1ELCBV

U0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFN0

YW5mb3JkIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdGFuZm9yZCwgQ0EsIFVTQS4m

I3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIFJveWFsIFByaW5jZSBBbGZyZWQgSG9z

cGl0YWwsIFN5ZG5leSwgTlNXLCBBdXN0cmFsaWEuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0

bGU+V2hhdCBpcyB0aGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBq

dW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uPyBldmFsdWF0aW9uIG9mIDYwIHBhdGllbnRzIGF0

IGEgdGVydGlhcnkgcmVmZXJyYWwgY2VudGVyPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJv

Z2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1

bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhl

IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxp

dHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0

bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1w

ZXJpb2RpY2FsPjx2b2x1bWU+Mjk8L3ZvbHVtZT48bnVtYmVyPjY8L251bWJlcj48ZWRpdGlvbj4y

MDE3LzA0LzExPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3

b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFz

ZXMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzL3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ29nYXN0cmljIEp1bmN0aW9uLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlRlcnRpYXJ5IENh

cmUgQ2VudGVyczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48

a2V5d29yZD5keXNwaGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gKEVHSk9PKTwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24g

ZXNvcGhhZ2VhbCBwcmVzc3VyZSB0b3BvZ3JhcGh5IChIUkVQVCk8L2tleXdvcmQ+PC9rZXl3b3Jk

cz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1

Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yODM5

MzQzNzwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjExMTEvbm1vLjEzMDYxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8

L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [5]. However, Endoscopic Ultrasound (EUS) should be considered as a complementary imaging technique if there is a suspicion of an infiltrating or submucosal tumor of the EGJ or cardia. This is especially true in older individual with relatively recent onset of symptoms (< 6 mo).Management of EGJOOSince the etiologies of EGJOO are diverse, the treatment strategy relies on accurate diagnosis and treatment of the underlying etiology. Proton pump inhibitors are the treatment for reflux esophagitis and the first step in the management algorithm for EoE before escalating to further therapy such as topical steroids ADDIN EN.CITE <EndNote><Cite><Author>Molina-Infante</Author><Year>2017</Year><RecNum>2349</RecNum><DisplayText><style face="superscript">[17]</style></DisplayText><record><rec-number>2349</rec-number><foreign-keys><key app="EN" db-id="50wxdpzd9vd5r7e9t5b595djrfpttrxw9avp" timestamp="1535321361">2349</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Molina-Infante, J.</author><author>Lucendo, A. J.</author></authors></contributors><auth-address>Department of Gastroenterology, Hospital Universitario San Pedro de Alcantara, Caceres, Spain.&#xD;Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain.&#xD;Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.</auth-address><titles><title>Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: A Paradigm Shift</title><secondary-title>Am J Gastroenterol</secondary-title><alt-title>The American journal of gastroenterology</alt-title></titles><periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></periodical><alt-periodical><full-title>Am J Gastroenterol</full-title><abbr-1>The American journal of gastroenterology</abbr-1></alt-periodical><pages>1770-1773</pages><volume>112</volume><number>12</number><edition>2017/11/01</edition><dates><year>2017</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0002-9270</isbn><accession-num>29087399</accession-num><urls></urls><electronic-resource-num>10.1038/ajg.2017.404</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[17]. Esophageal strictures and rings should be treated with esophageal dilation. Patients with post –fundoplication dysphagia usually respond to redo operations of conversion to partial fundoplication or complete reversal. Functional EGJOO (when no structural abnormality is found) seems to carry a benign coursePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzYsIDE4XTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzMzk8

L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2

ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTUzMzc2NTk2NSI+MjMzOTwv

a2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9y

ZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U2NodXBhY2ssIEQuPC9hdXRo

b3I+PGF1dGhvcj5LYXR6a2EsIEQuIEEuPC9hdXRob3I+PGF1dGhvcj5HZW5vLCBELiBNLjwvYXV0

aG9yPjxhdXRob3I+UmF2aSwgSy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1

dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhlcGF0b2xvZ3ks

IE1heW8gQ2xpbmljLCBSb2NoZXN0ZXIsIE1OLCBVU0EuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+VGhlIGNsaW5pY2FsIHNpZ25pZmljYW5jZSBvZiBlc29waGFnb2dhc3RyaWMganVuY3Rp

b24gb3V0ZmxvdyBvYnN0cnVjdGlvbiBhbmQgaHlwZXJjb250cmFjdGlsZSBlc29waGFndXMgaW4g

aGlnaCByZXNvbHV0aW9uIGVzb3BoYWdlYWwgbWFub21ldHJ5PC90aXRsZT48c2Vjb25kYXJ5LXRp

dGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs

IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10

aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wg

TW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGls

aXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGlu

YWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+

PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+

TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs

IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnIt

MT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xLTk8L3BhZ2VzPjx2b2x1bWU+Mjk8L3ZvbHVtZT48

bnVtYmVyPjEwPC9udW1iZXI+PGVkaXRpb24+MjAxNy8wNS8yNjwvZWRpdGlvbj48a2V5d29yZHM+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVycy9jb21wbGljYXRpb25zLypkaWFnbm9zaXM8L2tl

eXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9uL3BhdGhvbG9neTwva2V5d29y

ZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3

b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5PC9rZXl3b3JkPjxrZXl3b3JkPk1p

ZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBvdXRm

bG93IG9ic3RydWN0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPmh5cGVyY29udHJhY3RpbGUgZXNvcGhh

Z3VzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5PY3Q8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xMzUwLTE5MjU8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjg1NDQ2NzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxl

bGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMzEwNTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1w

cm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1

dGhvcj5QZXJlei1GZXJuYW5kZXo8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNOdW0+MjM0

MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MjwvcmVjLW51bWJlcj48Zm9yZWlnbi1r

ZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1OTVkanJmcHR0cnh3

OWF2cCIgdGltZXN0YW1wPSIxNTMzOTQ4NzYzIj4yMzQyPC9rZXk+PC9mb3JlaWduLWtleXM+PHJl

Zi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+

PGF1dGhvcnM+PGF1dGhvcj5QZXJlei1GZXJuYW5kZXosIE0uIFQuPC9hdXRob3I+PGF1dGhvcj5T

YW50YW5kZXIsIEMuPC9hdXRob3I+PGF1dGhvcj5NYXJpbmVybywgQS48L2F1dGhvcj48YXV0aG9y

PkJ1cmdvcy1TYW50YW1hcmlhLCBELjwvYXV0aG9yPjxhdXRob3I+Q2hhdmFycmlhLUhlcmJvem8s

IEMuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0

bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBMYSBQcmluY2VzYSBVbml2

ZXJzaXR5IEhvc3BpdGFsLCBJbnN0aXR1dG8gZGUgSW52ZXN0aWdhY2lvbiBTYW5pdGFyaWEgUHJp

bmNlc2EgKElQKSwgTWFkcmlkLCBTcGFpbi4mI3hEO0NlbnRybyBkZSBJbnZlc3RpZ2FjaW9uIEJp

b21lZGljYSBlbiBSZWQgZGUgRW5mZXJtZWRhZGVzIEhlcGF0aWNhcyB5IERpZ2VzdGl2YXMgKENJ

QkVSRUhEKSwgTWFkcmlkLCBTcGFpbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5DaGFy

YWN0ZXJpemF0aW9uIGFuZCBmb2xsb3ctdXAgb2YgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91

dGZsb3cgb2JzdHJ1Y3Rpb24gZGV0ZWN0ZWQgYnkgaGlnaCByZXNvbHV0aW9uIG1hbm9tZXRyeTwv

dGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3NlY29uZGFy

eS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0

aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3Rp

bGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L3BlcmlvZGlj

YWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwv

ZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0

aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3Rp

bGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTE2LTI2PC9wYWdl

cz48dm9sdW1lPjI4PC92b2x1bWU+PG51bWJlcj4xPC9udW1iZXI+PGVkaXRpb24+MjAxNS8xMS8w

MTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWNldHlsY2hvbGluZSBSZWxlYXNlIEluaGli

aXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxr

ZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Qm90dWxpbnVtIFRveGlucy90aGVyYXBldXRp

YyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+Q2FzZS1Db250cm9sIFN0dWRpZXM8L2tleXdvcmQ+PGtl

eXdvcmQ+Q29ob3J0IFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+RGVnbHV0aXRpb24gRGlzb3Jk

ZXJzLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RGlsYXRhdGlvbi9tZXRob2Rz

PC9rZXl3b3JkPjxrZXl3b3JkPkRpc2Vhc2UgUHJvZ3Jlc3Npb248L2tleXdvcmQ+PGtleXdvcmQ+

RW5kb3Njb3B5LCBEaWdlc3RpdmUgU3lzdGVtL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnMvY29tcGxpY2F0aW9ucy8qcGh5c2lvcGF0aG9sb2d5

L3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBTcGhpbmN0ZXIsIExvd2VyL3Bo

eXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24v

KnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdv

cmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvY29tcGxpY2F0aW9ucy8qcGh5c2lvcGF0aG9sb2d5

PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3Jk

PjxrZXl3b3JkPk1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29y

ZD48a2V5d29yZD5Qcm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlJldHJvc3Bl

Y3RpdmUgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5DaGljYWdvIGNsYXNzaWZpY2F0aW9uPC9r

ZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBvdXRmbG93IG9ic3RydWN0

aW9uPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2ggcmVzb2x1dGlvbiBtYW5vbWV0cnk8L2tleXdvcmQ+

PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkphbjwv

ZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9u

LW51bT4yNjUxNzk3ODwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVz

b3VyY2UtbnVtPjEwLjExMTEvbm1vLjEyNzA4PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVt

b3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5n

dWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzYsIDE4XTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzMzk8

L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2

ZDVyN2U5dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTUzMzc2NTk2NSI+MjMzOTwv

a2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9y

ZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U2NodXBhY2ssIEQuPC9hdXRo

b3I+PGF1dGhvcj5LYXR6a2EsIEQuIEEuPC9hdXRob3I+PGF1dGhvcj5HZW5vLCBELiBNLjwvYXV0

aG9yPjxhdXRob3I+UmF2aSwgSy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1

dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhlcGF0b2xvZ3ks

IE1heW8gQ2xpbmljLCBSb2NoZXN0ZXIsIE1OLCBVU0EuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+VGhlIGNsaW5pY2FsIHNpZ25pZmljYW5jZSBvZiBlc29waGFnb2dhc3RyaWMganVuY3Rp

b24gb3V0ZmxvdyBvYnN0cnVjdGlvbiBhbmQgaHlwZXJjb250cmFjdGlsZSBlc29waGFndXMgaW4g

aGlnaCByZXNvbHV0aW9uIGVzb3BoYWdlYWwgbWFub21ldHJ5PC90aXRsZT48c2Vjb25kYXJ5LXRp

dGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs

IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10

aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wg

TW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGls

aXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGlu

YWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+

PGZ1bGwtdGl0bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+

TmV1cm9nYXN0cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFs

IG9mIHRoZSBFdXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnIt

MT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xLTk8L3BhZ2VzPjx2b2x1bWU+Mjk8L3ZvbHVtZT48

bnVtYmVyPjEwPC9udW1iZXI+PGVkaXRpb24+MjAxNy8wNS8yNjwvZWRpdGlvbj48a2V5d29yZHM+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVycy9jb21wbGljYXRpb25zLypkaWFnbm9zaXM8L2tl

eXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ29nYXN0cmljIEp1bmN0aW9uL3BhdGhvbG9neTwva2V5d29y

ZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3

b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5PC9rZXl3b3JkPjxrZXl3b3JkPk1p

ZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBvdXRm

bG93IG9ic3RydWN0aW9uPC9rZXl3b3JkPjxrZXl3b3JkPmh5cGVyY29udHJhY3RpbGUgZXNvcGhh

Z3VzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5PY3Q8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4xMzUwLTE5MjU8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjg1NDQ2NzA8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxl

bGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMTExL25tby4xMzEwNTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1w

cm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1

dGhvcj5QZXJlei1GZXJuYW5kZXo8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNOdW0+MjM0

MjwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MjwvcmVjLW51bWJlcj48Zm9yZWlnbi1r

ZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0NWI1OTVkanJmcHR0cnh3

OWF2cCIgdGltZXN0YW1wPSIxNTMzOTQ4NzYzIj4yMzQyPC9rZXk+PC9mb3JlaWduLWtleXM+PHJl

Zi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+

PGF1dGhvcnM+PGF1dGhvcj5QZXJlei1GZXJuYW5kZXosIE0uIFQuPC9hdXRob3I+PGF1dGhvcj5T

YW50YW5kZXIsIEMuPC9hdXRob3I+PGF1dGhvcj5NYXJpbmVybywgQS48L2F1dGhvcj48YXV0aG9y

PkJ1cmdvcy1TYW50YW1hcmlhLCBELjwvYXV0aG9yPjxhdXRob3I+Q2hhdmFycmlhLUhlcmJvem8s

IEMuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0

bWVudCBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBMYSBQcmluY2VzYSBVbml2

ZXJzaXR5IEhvc3BpdGFsLCBJbnN0aXR1dG8gZGUgSW52ZXN0aWdhY2lvbiBTYW5pdGFyaWEgUHJp

bmNlc2EgKElQKSwgTWFkcmlkLCBTcGFpbi4mI3hEO0NlbnRybyBkZSBJbnZlc3RpZ2FjaW9uIEJp

b21lZGljYSBlbiBSZWQgZGUgRW5mZXJtZWRhZGVzIEhlcGF0aWNhcyB5IERpZ2VzdGl2YXMgKENJ

QkVSRUhEKSwgTWFkcmlkLCBTcGFpbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5DaGFy

YWN0ZXJpemF0aW9uIGFuZCBmb2xsb3ctdXAgb2YgZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91

dGZsb3cgb2JzdHJ1Y3Rpb24gZGV0ZWN0ZWQgYnkgaGlnaCByZXNvbHV0aW9uIG1hbm9tZXRyeTwv

dGl0bGU+PHNlY29uZGFyeS10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L3NlY29uZGFy

eS10aXRsZT48YWx0LXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0

aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3Rp

bGl0eSBTb2NpZXR5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L3BlcmlvZGlj

YWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3RpbDwv

ZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkgOiB0

aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBNb3Rp

bGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MTE2LTI2PC9wYWdl

cz48dm9sdW1lPjI4PC92b2x1bWU+PG51bWJlcj4xPC9udW1iZXI+PGVkaXRpb24+MjAxNS8xMS8w

MTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWNldHlsY2hvbGluZSBSZWxlYXNlIEluaGli

aXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFkdWx0PC9rZXl3b3JkPjxr

ZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+Qm90dWxpbnVtIFRveGlucy90aGVyYXBldXRp

YyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+Q2FzZS1Db250cm9sIFN0dWRpZXM8L2tleXdvcmQ+PGtl

eXdvcmQ+Q29ob3J0IFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+RGVnbHV0aXRpb24gRGlzb3Jk

ZXJzLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RGlsYXRhdGlvbi9tZXRob2Rz

PC9rZXl3b3JkPjxrZXl3b3JkPkRpc2Vhc2UgUHJvZ3Jlc3Npb248L2tleXdvcmQ+PGtleXdvcmQ+

RW5kb3Njb3B5LCBEaWdlc3RpdmUgU3lzdGVtL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ2VhbCBNb3RpbGl0eSBEaXNvcmRlcnMvY29tcGxpY2F0aW9ucy8qcGh5c2lvcGF0aG9sb2d5

L3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBTcGhpbmN0ZXIsIExvd2VyL3Bo

eXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24v

KnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdv

cmQ+R2FzdHJvZXNvcGhhZ2VhbCBSZWZsdXgvY29tcGxpY2F0aW9ucy8qcGh5c2lvcGF0aG9sb2d5

PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3Jk

PjxrZXl3b3JkPk1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD5NaWRkbGUgQWdlZDwva2V5d29y

ZD48a2V5d29yZD5Qcm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3JkPlJldHJvc3Bl

Y3RpdmUgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5DaGljYWdvIGNsYXNzaWZpY2F0aW9uPC9r

ZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBvdXRmbG93IG9ic3RydWN0

aW9uPC9rZXl3b3JkPjxrZXl3b3JkPmhpZ2ggcmVzb2x1dGlvbiBtYW5vbWV0cnk8L2tleXdvcmQ+

PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkphbjwv

ZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9u

LW51bT4yNjUxNzk3ODwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVz

b3VyY2UtbnVtPjEwLjExMTEvbm1vLjEyNzA4PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVt

b3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5n

dWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [6,18], especially if it is an incidental diagnosis. In one study, despite that only 15/30 (50%) patients with EGJOO received any specific treatment, 19/30 (68%) patients had symptomatic improvement after a mean follow up period of 30 wkPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1cGFjazwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzM5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzZdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjMzOTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzNzY1OTY1Ij4yMzM5PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5TY2h1cGFjaywgRC48L2F1dGhvcj48

YXV0aG9yPkthdHprYSwgRC4gQS48L2F1dGhvcj48YXV0aG9yPkdlbm8sIEQuIE0uPC9hdXRob3I+

PGF1dGhvcj5SYXZpLCBLLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h

ZGRyZXNzPkRlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWF5

byBDbGluaWMsIFJvY2hlc3RlciwgTU4sIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5UaGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBqdW5jdGlvbiBv

dXRmbG93IG9ic3RydWN0aW9uIGFuZCBoeXBlcmNvbnRyYWN0aWxlIGVzb3BoYWd1cyBpbiBoaWdo

IHJlc29sdXRpb24gZXNvcGhhZ2VhbCBtYW5vbWV0cnk8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPk5ldXJvZ2FzdHJvZW50ZXJvbCBNb3Rp

bDwvZnVsbC10aXRsZT48YWJici0xPk5ldXJvZ2FzdHJvZW50ZXJvbG9neSBhbmQgbW90aWxpdHkg

OiB0aGUgb2ZmaWNpYWwgam91cm5hbCBvZiB0aGUgRXVyb3BlYW4gR2FzdHJvaW50ZXN0aW5hbCBN

b3RpbGl0eSBTb2NpZXR5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwtdGl0bGU+PGFiYnItMT5OZXVy

b2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9mZmljaWFsIGpvdXJuYWwgb2Yg

dGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkgU29jaWV0eTwvYWJici0xPjwv

YWx0LXBlcmlvZGljYWw+PHBhZ2VzPjEtOTwvcGFnZXM+PHZvbHVtZT4yOTwvdm9sdW1lPjxudW1i

ZXI+MTA8L251bWJlcj48ZWRpdGlvbj4yMDE3LzA1LzI2PC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5

d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlYWwgTW90aWxpdHkgRGlzb3JkZXJzL2NvbXBsaWNhdGlvbnMvKmRpYWdub3Npczwva2V5d29y

ZD48a2V5d29yZD5Fc29waGFnb2dhc3RyaWMgSnVuY3Rpb24vcGF0aG9sb2d5PC9rZXl3b3JkPjxr

ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+

TWFsZTwva2V5d29yZD48a2V5d29yZD5NYW5vbWV0cnk8L2tleXdvcmQ+PGtleXdvcmQ+TWlkZGxl

IEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIGp1bmN0aW9uIG91dGZsb3cg

b2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aHlwZXJjb250cmFjdGlsZSBlc29waGFndXM8

L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxk

YXRlPk9jdDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48

YWNjZXNzaW9uLW51bT4yODU0NDY3MDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjExMTEvbm1vLjEzMTA1PC9lbGVjdHJvbmljLXJlc291cmNl

LW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3Zp

ZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [6]. In another study, among the 13 patients with EGJOO who did not receive any specific therapy, 12 (92%) patients had spontaneous symptomatic resolution of their symptoms over a follow up period of 6 moPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZXJlei1GZXJuYW5kZXo8L0F1dGhvcj48WWVhcj4yMDE2

PC9ZZWFyPjxSZWNOdW0+MjM0MjwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3Vw

ZXJzY3JpcHQiPlsxOF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4y

MzQyPC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRw

emQ5dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM5NDg3NjMiPjIz

NDI8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4x

NzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlBlcmV6LUZlcm5hbmRl

eiwgTS4gVC48L2F1dGhvcj48YXV0aG9yPlNhbnRhbmRlciwgQy48L2F1dGhvcj48YXV0aG9yPk1h

cmluZXJvLCBBLjwvYXV0aG9yPjxhdXRob3I+QnVyZ29zLVNhbnRhbWFyaWEsIEQuPC9hdXRob3I+

PGF1dGhvcj5DaGF2YXJyaWEtSGVyYm96bywgQy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmli

dXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhl

cGF0b2xvZ3ksIExhIFByaW5jZXNhIFVuaXZlcnNpdHkgSG9zcGl0YWwsIEluc3RpdHV0byBkZSBJ

bnZlc3RpZ2FjaW9uIFNhbml0YXJpYSBQcmluY2VzYSAoSVApLCBNYWRyaWQsIFNwYWluLiYjeEQ7

Q2VudHJvIGRlIEludmVzdGlnYWNpb24gQmlvbWVkaWNhIGVuIFJlZCBkZSBFbmZlcm1lZGFkZXMg

SGVwYXRpY2FzIHkgRGlnZXN0aXZhcyAoQ0lCRVJFSEQpLCBNYWRyaWQsIFNwYWluLjwvYXV0aC1h

ZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNoYXJhY3Rlcml6YXRpb24gYW5kIGZvbGxvdy11cCBvZiBl

c29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0cnVjdGlvbiBkZXRlY3RlZCBieSBo

aWdoIHJlc29sdXRpb24gbWFub21ldHJ5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3RpdGxl

cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwt

dGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9m

ZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkg

U29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1wZXJp

b2RpY2FsPjxwYWdlcz4xMTYtMjY8L3BhZ2VzPjx2b2x1bWU+Mjg8L3ZvbHVtZT48bnVtYmVyPjE8

L251bWJlcj48ZWRpdGlvbj4yMDE1LzExLzAxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5B

Y2V0eWxjaG9saW5lIFJlbGVhc2UgSW5oaWJpdG9ycy90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5C

b3R1bGludW0gVG94aW5zL3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5DYXNlLUNv

bnRyb2wgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5Db2hvcnQgU3R1ZGllczwva2V5d29yZD48

a2V5d29yZD5EZWdsdXRpdGlvbiBEaXNvcmRlcnMvKnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48

a2V5d29yZD5EaWxhdGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RGlzZWFzZSBQcm9n

cmVzc2lvbjwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHksIERpZ2VzdGl2ZSBTeXN0ZW0vbWV0

aG9kczwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVycy9jb21w

bGljYXRpb25zLypwaHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29w

aGFnZWFsIFNwaGluY3RlciwgTG93ZXIvcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3Jk

PkVzb3BoYWdvZ2FzdHJpYyBKdW5jdGlvbi8qcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3

b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC9jb21w

bGljYXRpb25zLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3

b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5PC9rZXl3b3JkPjxr

ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8

L2tleXdvcmQ+PGtleXdvcmQ+UmV0cm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3Jk

PkNoaWNhZ28gY2xhc3NpZmljYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmlj

IGp1bmN0aW9uIG91dGZsb3cgb2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aGlnaCByZXNv

bHV0aW9uIG1hbm9tZXRyeTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE2PC95

ZWFyPjxwdWItZGF0ZXM+PGRhdGU+SmFuPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+

MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI2NTE3OTc4PC9hY2Nlc3Npb24tbnVtPjx1

cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTExMS9ubW8uMTI3MDg8L2Vs

ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1v

dGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9D

aXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZXJlei1GZXJuYW5kZXo8L0F1dGhvcj48WWVhcj4yMDE2

PC9ZZWFyPjxSZWNOdW0+MjM0MjwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3Vw

ZXJzY3JpcHQiPlsxOF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4y

MzQyPC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRw

emQ5dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1MzM5NDg3NjMiPjIz

NDI8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4x

NzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlBlcmV6LUZlcm5hbmRl

eiwgTS4gVC48L2F1dGhvcj48YXV0aG9yPlNhbnRhbmRlciwgQy48L2F1dGhvcj48YXV0aG9yPk1h

cmluZXJvLCBBLjwvYXV0aG9yPjxhdXRob3I+QnVyZ29zLVNhbnRhbWFyaWEsIEQuPC9hdXRob3I+

PGF1dGhvcj5DaGF2YXJyaWEtSGVyYm96bywgQy48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmli

dXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3kgYW5kIEhl

cGF0b2xvZ3ksIExhIFByaW5jZXNhIFVuaXZlcnNpdHkgSG9zcGl0YWwsIEluc3RpdHV0byBkZSBJ

bnZlc3RpZ2FjaW9uIFNhbml0YXJpYSBQcmluY2VzYSAoSVApLCBNYWRyaWQsIFNwYWluLiYjeEQ7

Q2VudHJvIGRlIEludmVzdGlnYWNpb24gQmlvbWVkaWNhIGVuIFJlZCBkZSBFbmZlcm1lZGFkZXMg

SGVwYXRpY2FzIHkgRGlnZXN0aXZhcyAoQ0lCRVJFSEQpLCBNYWRyaWQsIFNwYWluLjwvYXV0aC1h

ZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNoYXJhY3Rlcml6YXRpb24gYW5kIGZvbGxvdy11cCBvZiBl

c29waGFnb2dhc3RyaWMganVuY3Rpb24gb3V0ZmxvdyBvYnN0cnVjdGlvbiBkZXRlY3RlZCBieSBo

aWdoIHJlc29sdXRpb24gbWFub21ldHJ5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJvZ2Fz

dHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3RpdGxl

cz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1bGwt

dGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhlIG9m

ZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxpdHkg

U29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+

TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0cm9l

bnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBFdXJv

cGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1wZXJp

b2RpY2FsPjxwYWdlcz4xMTYtMjY8L3BhZ2VzPjx2b2x1bWU+Mjg8L3ZvbHVtZT48bnVtYmVyPjE8

L251bWJlcj48ZWRpdGlvbj4yMDE1LzExLzAxPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5B

Y2V0eWxjaG9saW5lIFJlbGVhc2UgSW5oaWJpdG9ycy90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5C

b3R1bGludW0gVG94aW5zL3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5DYXNlLUNv

bnRyb2wgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5Db2hvcnQgU3R1ZGllczwva2V5d29yZD48

a2V5d29yZD5EZWdsdXRpdGlvbiBEaXNvcmRlcnMvKnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48

a2V5d29yZD5EaWxhdGF0aW9uL21ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+RGlzZWFzZSBQcm9n

cmVzc2lvbjwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHksIERpZ2VzdGl2ZSBTeXN0ZW0vbWV0

aG9kczwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIE1vdGlsaXR5IERpc29yZGVycy9jb21w

bGljYXRpb25zLypwaHlzaW9wYXRob2xvZ3kvdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29w

aGFnZWFsIFNwaGluY3RlciwgTG93ZXIvcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3Jk

PkVzb3BoYWdvZ2FzdHJpYyBKdW5jdGlvbi8qcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3

b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5HYXN0cm9lc29waGFnZWFsIFJlZmx1eC9jb21w

bGljYXRpb25zLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3

b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5PC9rZXl3b3JkPjxr

ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlByb3NwZWN0aXZlIFN0dWRpZXM8

L2tleXdvcmQ+PGtleXdvcmQ+UmV0cm9zcGVjdGl2ZSBTdHVkaWVzPC9rZXl3b3JkPjxrZXl3b3Jk

PkNoaWNhZ28gY2xhc3NpZmljYXRpb248L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmlj

IGp1bmN0aW9uIG91dGZsb3cgb2JzdHJ1Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aGlnaCByZXNv

bHV0aW9uIG1hbm9tZXRyeTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDE2PC95

ZWFyPjxwdWItZGF0ZXM+PGRhdGU+SmFuPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+

MTM1MC0xOTI1PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjI2NTE3OTc4PC9hY2Nlc3Npb24tbnVtPjx1

cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTExMS9ubW8uMTI3MDg8L2Vs

ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1v

dGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9D

aXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE.DATA [18]. Since asymptomatic or minimally symptomatic cases may resolve without any intervention, observation with a follow up manometry is a reasonable approach before deciding on any therapy directed at the LES in cases of functional EGJOO. When there is retention of barium tablet at the EGJ, bougie dilation to 18-20 mm may be indicated and failure may need to be treated with pneumatic dilation and/or botulinum injectionPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DbGF5dG9uPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48

UmVjTnVtPjIzNDU8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bMTldPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0NTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM0MTk3MjMxIj4yMzQ1PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DbGF5dG9uLCBTLiBCLjwvYXV0aG9y

PjxhdXRob3I+UGF0ZWwsIFIuPC9hdXRob3I+PGF1dGhvcj5SaWNodGVyLCBKLiBFLjwvYXV0aG9y

PjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlVuaXZlcnNpdHkgb2YgU291

dGggQ2Fyb2xpbmEgU2Nob29sIG9mIE1lZGljaW5lLCBHcmVlbnZpbGxlLCBHcmVlbnZpbGxlIEhl

YWx0aCBTeXN0ZW0gR2FzdHJvZW50ZXJvbG9neSBhbmQgTGl2ZXIgQ2VudGVyLCBHcmVlbnZpbGxl

LCBTb3V0aCBDYXJvbGluYS4gRWxlY3Ryb25pYyBhZGRyZXNzOiB6c2JjMTBAZ21haWwuY29tLiYj

eEQ7RGVwYXJ0bWVudCBvZiBJbnRlcm5hbCBNZWRpY2luZSwgRGl2aXNpb24gb2YgRGlnZXN0aXZl

IERpc2Vhc2VzIGFuZCBOdXRyaXRpb24sIEpveSBNY0Nhbm4gQ3VsdmVyaG91c2UgQ2VudGVyIGZv

ciBTd2FsbG93aW5nIERpc29yZGVycywgVW5pdmVyc2l0eSBvZiBTb3V0aCBGbG9yaWRhLCBUYW1w

YSwgRmxvcmlkYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5GdW5jdGlvbmFsIGFuZCBB

bmF0b21pYyBFc29waGFnb2dhc3RpYyBKdW5jdGlvbiBPdXRmbG93IE9ic3RydWN0aW9uOiBNYW5v

bWV0cnksIFRpbWVkIEJhcml1bSBFc29waGFncmFtIEZpbmRpbmdzLCBhbmQgVHJlYXRtZW50IE91

dGNvbWVzPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9s

PC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFu

ZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2Yg

dGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FsdC10aXRsZT48

L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRv

bDwvZnVsbC10aXRsZT48YWJici0xPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0

b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1l

cmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWJici0xPjwvcGVyaW9kaWNh

bD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8

L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9s

b2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJp

Y2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L2FsdC1wZXJpb2Rp

Y2FsPjxwYWdlcz45MDctOTExPC9wYWdlcz48dm9sdW1lPjE0PC92b2x1bWU+PG51bWJlcj42PC9u

dW1iZXI+PGVkaXRpb24+MjAxNi8wMS8yMzwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWdl

ZDwva2V5d29yZD48a2V5d29yZD5CYXJpdW0vYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlPC9r

ZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFzZXMvKmRpYWdub3Npcy9kaWFnbm9zdGlj

IGltYWdpbmcvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3

b3JkPkdhc3Ryb2ludGVzdGluYWwgRGlzZWFzZXMvKmRpYWdub3Npcy9kaWFnbm9zdGljIGltYWdp

bmcvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1h

bGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5LyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3Jk

PlJhZGlvZ3JhcGh5LCBUaG9yYWNpYy8qbWV0aG9kczwva2V5d29yZD48a2V5d29yZD5SZXRyb3Nw

ZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdv

cmQ+PGtleXdvcmQ+KkR5c3BoYWdpYTwva2V5d29yZD48a2V5d29yZD4qZWdqb288L2tleXdvcmQ+

PGtleXdvcmQ+KmhybTwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNvbHV0aW9uIE1hbm9tZXRy

eTwva2V5d29yZD48a2V5d29yZD4qVGltZWQgQmFyaXVtIFN3YWxsb3c8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1NDItMzU2NTwvaXNibj48YWNjZXNzaW9uLW51bT4y

Njc5MjM3NDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjEwLjEwMTYvai5jZ2guMjAxNS4xMi4wNDE8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxy

ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxh

bmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DbGF5dG9uPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48

UmVjTnVtPjIzNDU8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0

Ij5bMTldPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0NTwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTM0MTk3MjMxIj4yMzQ1PC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5DbGF5dG9uLCBTLiBCLjwvYXV0aG9y

PjxhdXRob3I+UGF0ZWwsIFIuPC9hdXRob3I+PGF1dGhvcj5SaWNodGVyLCBKLiBFLjwvYXV0aG9y

PjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlVuaXZlcnNpdHkgb2YgU291

dGggQ2Fyb2xpbmEgU2Nob29sIG9mIE1lZGljaW5lLCBHcmVlbnZpbGxlLCBHcmVlbnZpbGxlIEhl

YWx0aCBTeXN0ZW0gR2FzdHJvZW50ZXJvbG9neSBhbmQgTGl2ZXIgQ2VudGVyLCBHcmVlbnZpbGxl

LCBTb3V0aCBDYXJvbGluYS4gRWxlY3Ryb25pYyBhZGRyZXNzOiB6c2JjMTBAZ21haWwuY29tLiYj

eEQ7RGVwYXJ0bWVudCBvZiBJbnRlcm5hbCBNZWRpY2luZSwgRGl2aXNpb24gb2YgRGlnZXN0aXZl

IERpc2Vhc2VzIGFuZCBOdXRyaXRpb24sIEpveSBNY0Nhbm4gQ3VsdmVyaG91c2UgQ2VudGVyIGZv

ciBTd2FsbG93aW5nIERpc29yZGVycywgVW5pdmVyc2l0eSBvZiBTb3V0aCBGbG9yaWRhLCBUYW1w

YSwgRmxvcmlkYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5GdW5jdGlvbmFsIGFuZCBB

bmF0b21pYyBFc29waGFnb2dhc3RpYyBKdW5jdGlvbiBPdXRmbG93IE9ic3RydWN0aW9uOiBNYW5v

bWV0cnksIFRpbWVkIEJhcml1bSBFc29waGFncmFtIEZpbmRpbmdzLCBhbmQgVHJlYXRtZW50IE91

dGNvbWVzPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9s

PC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFu

ZCBoZXBhdG9sb2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2Yg

dGhlIEFtZXJpY2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FsdC10aXRsZT48

L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRv

bDwvZnVsbC10aXRsZT48YWJici0xPkNsaW5pY2FsIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0

b2xvZ3kgOiB0aGUgb2ZmaWNpYWwgY2xpbmljYWwgcHJhY3RpY2Ugam91cm5hbCBvZiB0aGUgQW1l

cmljYW4gR2FzdHJvZW50ZXJvbG9naWNhbCBBc3NvY2lhdGlvbjwvYWJici0xPjwvcGVyaW9kaWNh

bD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8

L2Z1bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9s

b2d5IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJp

Y2FuIEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L2FsdC1wZXJpb2Rp

Y2FsPjxwYWdlcz45MDctOTExPC9wYWdlcz48dm9sdW1lPjE0PC92b2x1bWU+PG51bWJlcj42PC9u

dW1iZXI+PGVkaXRpb24+MjAxNi8wMS8yMzwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWdl

ZDwva2V5d29yZD48a2V5d29yZD5CYXJpdW0vYWRtaW5pc3RyYXRpb24gJmFtcDsgZG9zYWdlPC9r

ZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFzZXMvKmRpYWdub3Npcy9kaWFnbm9zdGlj

IGltYWdpbmcvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3

b3JkPkdhc3Ryb2ludGVzdGluYWwgRGlzZWFzZXMvKmRpYWdub3Npcy9kaWFnbm9zdGljIGltYWdp

bmcvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1h

bGU8L2tleXdvcmQ+PGtleXdvcmQ+TWFub21ldHJ5LyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3Jk

PlJhZGlvZ3JhcGh5LCBUaG9yYWNpYy8qbWV0aG9kczwva2V5d29yZD48a2V5d29yZD5SZXRyb3Nw

ZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdv

cmQ+PGtleXdvcmQ+KkR5c3BoYWdpYTwva2V5d29yZD48a2V5d29yZD4qZWdqb288L2tleXdvcmQ+

PGtleXdvcmQ+KmhybTwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNvbHV0aW9uIE1hbm9tZXRy

eTwva2V5d29yZD48a2V5d29yZD4qVGltZWQgQmFyaXVtIFN3YWxsb3c8L2tleXdvcmQ+PC9rZXl3

b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48

L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE1NDItMzU2NTwvaXNibj48YWNjZXNzaW9uLW51bT4y

Njc5MjM3NDwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2Ut

bnVtPjEwLjEwMTYvai5jZ2guMjAxNS4xMi4wNDE8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxy

ZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxh

bmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A

ADDIN EN.CITE.DATA [19]. Peroral endoscopic myotomy (POEM) has showed promise in the management of functional EGJOO when symptoms persistPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaGFzaGFiPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48

UmVjTnVtPjEzMzwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsyMF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4xMzM8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0OWRlMDl4NWFhOTB2N2Vw

dHN0dmQwYW9mcGF4NWF4c3JmZmEiIHRpbWVzdGFtcD0iMTUzNjUyMDA3NSI+MTMzPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LaGFzaGFiLCBNLiBBLjwvYXV0aG9yPjxh

dXRob3I+RmFtaWxpYXJpLCBQLjwvYXV0aG9yPjxhdXRob3I+RHJhZ2Fub3YsIFAuIFYuPC9hdXRo

b3I+PGF1dGhvcj5BcmlkaSwgSC4gRC48L2F1dGhvcj48YXV0aG9yPkNobywgSi4gWS48L2F1dGhv

cj48YXV0aG9yPlVqaWtpLCBNLjwvYXV0aG9yPjxhdXRob3I+UmlvIFRpbnRvLCBSLjwvYXV0aG9y

PjxhdXRob3I+TG91aXMsIEguPC9hdXRob3I+PGF1dGhvcj5EZXNhaSwgUC4gTi48L2F1dGhvcj48

YXV0aG9yPlZlbGFub3ZpY2gsIFYuPC9hdXRob3I+PGF1dGhvcj5BbGJlbml6LCBFLjwvYXV0aG9y

PjxhdXRob3I+SGFqaSwgQS48L2F1dGhvcj48YXV0aG9yPk1hcmtzLCBKLjwvYXV0aG9yPjxhdXRo

b3I+Q29zdGFtYWduYSwgRy48L2F1dGhvcj48YXV0aG9yPkRldmllcmUsIEouPC9hdXRob3I+PGF1

dGhvcj5QZXJidGFuaSwgWS48L2F1dGhvcj48YXV0aG9yPkhlZGJlcmcsIE0uPC9hdXRob3I+PGF1

dGhvcj5Fc3RyZW1lcmEsIEYuPC9hdXRob3I+PGF1dGhvcj5NYXJ0aW4gRGVsIENhbXBvLCBMLiBB

LjwvYXV0aG9yPjxhdXRob3I+WWFuZywgRC48L2F1dGhvcj48YXV0aG9yPkJ1a2hhcmksIE0uPC9h

dXRob3I+PGF1dGhvcj5CcmV3ZXIsIE8uPC9hdXRob3I+PGF1dGhvcj5TYW5hZWksIE8uPC9hdXRo

b3I+PGF1dGhvcj5GYXlhZCwgTC48L2F1dGhvcj48YXV0aG9yPkFnYXJ3YWwsIEEuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkNoZW4sIFkuIEkuPC9hdXRob3I+

PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgR2FzdHJv

ZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgSm9obnMgSG9wa2lucyBNZWRpY2FsIEluc3RpdHV0

aW9ucywgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVW5pdGVkIFN0YXRlcy4mI3hEO0RpZ2VzdGl2ZSBF

bmRvc2NvcHkgVW5pdCwgVW5pdmVyc2l0YSBDYXR0b2xpY2EgZGVsIFNhY3JvIEN1b3JlLCBSb21l

LCBJdGFseS4mI3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEhlcGF0b2xvZ3kgYW5k

IE51dHJpdGlvbiwgVW5pdmVyc2l0eSBvZiBGbG9yaWRhLCBHYWluZXN2aWxsZSwgRmxvcmlkYSwg

VW5pdGVkIFN0YXRlcy4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgQ0hBIEJ1ZGFuZyBN

ZWRpY2FsIENlbnRlciwgQ0hBIFVuaXZlcnNpdHksIFNlb25nbmFtLCBLb3JlYS4mI3hEO0RlcGFy

dG1lbnQgb2YgU3VyZ2VyeSwgU2VjdGlvbiBvZiBNaW5pbWFsbHkgSW52YXNpdmUgU3VyZ2VyeSwg

Tm9ydGhTaG9yZSBVbml2ZXJzaXR5IEhlYWx0aCBTeXN0ZW0sIEV2YW5zdG9uLCBJbGxpbm9pcywg

VW5pdGVkIFN0YXRlcy4mI3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEhlcGF0b3Bh

bmNyZWF0b2xvZ3kgYW5kIERpZ2VzdGl2ZSBPbmNvbG9neSwgRXJhc21lIFVuaXZlcnNpdHkgSG9z

cGl0YWwsIFVuaXZlcnNpdGUgTGlicmUgZGUgQnJ1eGVsbGVzLiYjeEQ7U3VyYXQgSW5zdGl0dXRl

IG9mIERpZ2VzdGl2ZSBTY2llbmNlcywgU3VyYXQsIEluZGlhLiYjeEQ7RGl2aXNpb24gb2YgR2Vu

ZXJhbCBTdXJnZXJ5LCBVbml2ZXJzaXR5IG9mIFNvdXRoIEZsb3JpZGEgTW9yc2FuaSBDb2xsZWdl

IG9mIE1lZGljaW5lLCBUYW1wYSwgRmxvcmlkYSwgVW5pdGVkIFN0YXRlcy4mI3hEO0RpdmlzaW9u

IG9mIEdhc3Ryb2VudGVyb2xvZ3ksIENvbXBsZWpvIEhvc3BpdGFsYXJpbyBkZSBOYXZhcnJhLCBQ

YW1wbG9uYSwgU3BhaW4uJiN4RDtEZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEtpbmdz

IENvbGxlZ2UgSG9zcGl0YWwgTkhTIEZvdW5kYXRpb24gVHJ1c3QsIExvbmRvbiwgVUsuJiN4RDtE

ZXBhcnRtZW50IG9mIFN1cmdlcnksIFVuaXZlcnNpdHkgSG9zcGl0YWxzIENsZXZlbGFuZCBNZWRp

Y2FsIENlbnRlciwgQ2xldmVsYW5kLCBPaGlvLCBVbml0ZWQgU3RhdGVzLiYjeEQ7RGl2aXNpb24g

b2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWNHaWxsIFVuaXZlcnNpdHkgSGVh

bHRoIENlbnRlciwgTWNHaWxsIFVuaXZlcnNpdHksIE1vbnRyZWFsLCBRdWViZWMsIENhbmFkYS48

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QZXJvcmFsIGVuZG9zY29waWMgbXlvdG9teSBp

cyBlZmZlY3RpdmUgYW5kIHNhZmUgaW4gbm9uLWFjaGFsYXNpYSBlc29waGFnZWFsIG1vdGlsaXR5

IGRpc29yZGVyczogYW4gaW50ZXJuYXRpb25hbCBtdWx0aWNlbnRlciBzdHVkeTwvdGl0bGU+PHNl

Y29uZGFyeS10aXRsZT5FbmRvc2MgSW50IE9wZW48L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxl

PkVuZG9zY29weSBpbnRlcm5hdGlvbmFsIG9wZW48L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5FbmRvc2MgSW50IE9wZW48L2Z1bGwtdGl0bGU+PGFiYnItMT5FbmRv

c2NvcHkgaW50ZXJuYXRpb25hbCBvcGVuPC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5FbmRvc2MgSW50IE9wZW48L2Z1bGwtdGl0bGU+PGFiYnItMT5FbmRv

c2NvcHkgaW50ZXJuYXRpb25hbCBvcGVuPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+

RTEwMzEtZTEwMzY8L3BhZ2VzPjx2b2x1bWU+Njwvdm9sdW1lPjxudW1iZXI+ODwvbnVtYmVyPjxl

ZGl0aW9uPjIwMTgvMDgvMTU8L2VkaXRpb24+PGRhdGVzPjx5ZWFyPjIwMTg8L3llYXI+PHB1Yi1k

YXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4yMzY0LTM3MjIg

KFByaW50KSYjeEQ7MjE5Ni05NzM2PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjMwMTA1MjkwPC9hY2Nl

c3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM2MDg2NjgwPC9jdXN0b20yPjxlbGVj

dHJvbmljLXJlc291cmNlLW51bT4xMC4xMDU1L2EtMDYyNS02Mjg4PC9lbGVjdHJvbmljLXJlc291

cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXBy

b3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaGFzaGFiPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48

UmVjTnVtPjEzMzwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi

PlsyMF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4xMzM8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ0OWRlMDl4NWFhOTB2N2Vw

dHN0dmQwYW9mcGF4NWF4c3JmZmEiIHRpbWVzdGFtcD0iMTUzNjUyMDA3NSI+MTMzPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LaGFzaGFiLCBNLiBBLjwvYXV0aG9yPjxh

dXRob3I+RmFtaWxpYXJpLCBQLjwvYXV0aG9yPjxhdXRob3I+RHJhZ2Fub3YsIFAuIFYuPC9hdXRo

b3I+PGF1dGhvcj5BcmlkaSwgSC4gRC48L2F1dGhvcj48YXV0aG9yPkNobywgSi4gWS48L2F1dGhv

cj48YXV0aG9yPlVqaWtpLCBNLjwvYXV0aG9yPjxhdXRob3I+UmlvIFRpbnRvLCBSLjwvYXV0aG9y

PjxhdXRob3I+TG91aXMsIEguPC9hdXRob3I+PGF1dGhvcj5EZXNhaSwgUC4gTi48L2F1dGhvcj48

YXV0aG9yPlZlbGFub3ZpY2gsIFYuPC9hdXRob3I+PGF1dGhvcj5BbGJlbml6LCBFLjwvYXV0aG9y

PjxhdXRob3I+SGFqaSwgQS48L2F1dGhvcj48YXV0aG9yPk1hcmtzLCBKLjwvYXV0aG9yPjxhdXRo

b3I+Q29zdGFtYWduYSwgRy48L2F1dGhvcj48YXV0aG9yPkRldmllcmUsIEouPC9hdXRob3I+PGF1

dGhvcj5QZXJidGFuaSwgWS48L2F1dGhvcj48YXV0aG9yPkhlZGJlcmcsIE0uPC9hdXRob3I+PGF1

dGhvcj5Fc3RyZW1lcmEsIEYuPC9hdXRob3I+PGF1dGhvcj5NYXJ0aW4gRGVsIENhbXBvLCBMLiBB

LjwvYXV0aG9yPjxhdXRob3I+WWFuZywgRC48L2F1dGhvcj48YXV0aG9yPkJ1a2hhcmksIE0uPC9h

dXRob3I+PGF1dGhvcj5CcmV3ZXIsIE8uPC9hdXRob3I+PGF1dGhvcj5TYW5hZWksIE8uPC9hdXRo

b3I+PGF1dGhvcj5GYXlhZCwgTC48L2F1dGhvcj48YXV0aG9yPkFnYXJ3YWwsIEEuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkNoZW4sIFkuIEkuPC9hdXRob3I+

PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGl2aXNpb24gb2YgR2FzdHJv

ZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgSm9obnMgSG9wa2lucyBNZWRpY2FsIEluc3RpdHV0

aW9ucywgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVW5pdGVkIFN0YXRlcy4mI3hEO0RpZ2VzdGl2ZSBF

bmRvc2NvcHkgVW5pdCwgVW5pdmVyc2l0YSBDYXR0b2xpY2EgZGVsIFNhY3JvIEN1b3JlLCBSb21l

LCBJdGFseS4mI3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEhlcGF0b2xvZ3kgYW5k

IE51dHJpdGlvbiwgVW5pdmVyc2l0eSBvZiBGbG9yaWRhLCBHYWluZXN2aWxsZSwgRmxvcmlkYSwg

VW5pdGVkIFN0YXRlcy4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgQ0hBIEJ1ZGFuZyBN

ZWRpY2FsIENlbnRlciwgQ0hBIFVuaXZlcnNpdHksIFNlb25nbmFtLCBLb3JlYS4mI3hEO0RlcGFy

dG1lbnQgb2YgU3VyZ2VyeSwgU2VjdGlvbiBvZiBNaW5pbWFsbHkgSW52YXNpdmUgU3VyZ2VyeSwg

Tm9ydGhTaG9yZSBVbml2ZXJzaXR5IEhlYWx0aCBTeXN0ZW0sIEV2YW5zdG9uLCBJbGxpbm9pcywg

VW5pdGVkIFN0YXRlcy4mI3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEhlcGF0b3Bh

bmNyZWF0b2xvZ3kgYW5kIERpZ2VzdGl2ZSBPbmNvbG9neSwgRXJhc21lIFVuaXZlcnNpdHkgSG9z

cGl0YWwsIFVuaXZlcnNpdGUgTGlicmUgZGUgQnJ1eGVsbGVzLiYjeEQ7U3VyYXQgSW5zdGl0dXRl

IG9mIERpZ2VzdGl2ZSBTY2llbmNlcywgU3VyYXQsIEluZGlhLiYjeEQ7RGl2aXNpb24gb2YgR2Vu

ZXJhbCBTdXJnZXJ5LCBVbml2ZXJzaXR5IG9mIFNvdXRoIEZsb3JpZGEgTW9yc2FuaSBDb2xsZWdl

IG9mIE1lZGljaW5lLCBUYW1wYSwgRmxvcmlkYSwgVW5pdGVkIFN0YXRlcy4mI3hEO0RpdmlzaW9u

IG9mIEdhc3Ryb2VudGVyb2xvZ3ksIENvbXBsZWpvIEhvc3BpdGFsYXJpbyBkZSBOYXZhcnJhLCBQ

YW1wbG9uYSwgU3BhaW4uJiN4RDtEZXBhcnRtZW50IG9mIEdhc3Ryb2VudGVyb2xvZ3ksIEtpbmdz

IENvbGxlZ2UgSG9zcGl0YWwgTkhTIEZvdW5kYXRpb24gVHJ1c3QsIExvbmRvbiwgVUsuJiN4RDtE

ZXBhcnRtZW50IG9mIFN1cmdlcnksIFVuaXZlcnNpdHkgSG9zcGl0YWxzIENsZXZlbGFuZCBNZWRp

Y2FsIENlbnRlciwgQ2xldmVsYW5kLCBPaGlvLCBVbml0ZWQgU3RhdGVzLiYjeEQ7RGl2aXNpb24g

b2YgR2FzdHJvZW50ZXJvbG9neSBhbmQgSGVwYXRvbG9neSwgTWNHaWxsIFVuaXZlcnNpdHkgSGVh

bHRoIENlbnRlciwgTWNHaWxsIFVuaXZlcnNpdHksIE1vbnRyZWFsLCBRdWViZWMsIENhbmFkYS48

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5QZXJvcmFsIGVuZG9zY29waWMgbXlvdG9teSBp

cyBlZmZlY3RpdmUgYW5kIHNhZmUgaW4gbm9uLWFjaGFsYXNpYSBlc29waGFnZWFsIG1vdGlsaXR5

IGRpc29yZGVyczogYW4gaW50ZXJuYXRpb25hbCBtdWx0aWNlbnRlciBzdHVkeTwvdGl0bGU+PHNl

Y29uZGFyeS10aXRsZT5FbmRvc2MgSW50IE9wZW48L3NlY29uZGFyeS10aXRsZT48YWx0LXRpdGxl

PkVuZG9zY29weSBpbnRlcm5hdGlvbmFsIG9wZW48L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5FbmRvc2MgSW50IE9wZW48L2Z1bGwtdGl0bGU+PGFiYnItMT5FbmRv

c2NvcHkgaW50ZXJuYXRpb25hbCBvcGVuPC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5FbmRvc2MgSW50IE9wZW48L2Z1bGwtdGl0bGU+PGFiYnItMT5FbmRv

c2NvcHkgaW50ZXJuYXRpb25hbCBvcGVuPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+

RTEwMzEtZTEwMzY8L3BhZ2VzPjx2b2x1bWU+Njwvdm9sdW1lPjxudW1iZXI+ODwvbnVtYmVyPjxl

ZGl0aW9uPjIwMTgvMDgvMTU8L2VkaXRpb24+PGRhdGVzPjx5ZWFyPjIwMTg8L3llYXI+PHB1Yi1k

YXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4yMzY0LTM3MjIg

KFByaW50KSYjeEQ7MjE5Ni05NzM2PC9pc2JuPjxhY2Nlc3Npb24tbnVtPjMwMTA1MjkwPC9hY2Nl

c3Npb24tbnVtPjx1cmxzPjwvdXJscz48Y3VzdG9tMj5QTUM2MDg2NjgwPC9jdXN0b20yPjxlbGVj

dHJvbmljLXJlc291cmNlLW51bT4xMC4xMDU1L2EtMDYyNS02Mjg4PC9lbGVjdHJvbmljLXJlc291

cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXBy

b3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [20], but more data are needed at this time. Pharmacologic management with calcium channel blockers or other drugs that have an effect on smooth muscle relaxation are generally ineffective. Therefore, treatment of EGJOO should be personalized and based on the severity of the patient’s symptoms, age, and local expertisePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pa2VrZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl

Y051bT4yMzQxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MTwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzOTM4NzQ5Ij4yMzQxPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Pa2VrZSwgRi4gQy48L2F1dGhvcj48YXV0

aG9yPlJhamEsIFMuPC9hdXRob3I+PGF1dGhvcj5MeW5jaCwgSy4gTC48L2F1dGhvcj48YXV0aG9y

PkRoYWxsYSwgUy48L2F1dGhvcj48YXV0aG9yPk5hbmR3YW5pLCBNLjwvYXV0aG9yPjxhdXRob3I+

U3RlaW4sIEUuIE0uPC9hdXRob3I+PGF1dGhvcj5DaGFuZGVyIFJvbGFuZCwgQi48L2F1dGhvcj48

YXV0aG9yPktoYXNoYWIsIE0uIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkFodWphLCBOLiBLLjwvYXV0aG9y

PjxhdXRob3I+Q2xhcmtlLCBKLiBPLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEhvc3BpdGFsIE1lZGljaW5lLCBUaGUgSm9obnMgSG9w

a2lucyBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYj

eEQ7RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBFbW9yeSBV

bml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EsIFVTQS4mI3hEO0Rpdmlz

aW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgVW5pdmVyc2l0eSBvZiBQ

ZW5uc3lsdmFuaWEgU2Nob29sIG9mIE1lZGljaW5lLCBQaGlsYWRlbHBoaWEsIFBBLCBVU0EuJiN4

RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFRoZSBKb2hu

cyBIb3BraW5zIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1ELCBV

U0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFN0

YW5mb3JkIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdGFuZm9yZCwgQ0EsIFVTQS4m

I3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIFJveWFsIFByaW5jZSBBbGZyZWQgSG9z

cGl0YWwsIFN5ZG5leSwgTlNXLCBBdXN0cmFsaWEuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0

bGU+V2hhdCBpcyB0aGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBq

dW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uPyBldmFsdWF0aW9uIG9mIDYwIHBhdGllbnRzIGF0

IGEgdGVydGlhcnkgcmVmZXJyYWwgY2VudGVyPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJv

Z2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1

bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhl

IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxp

dHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0

bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1w

ZXJpb2RpY2FsPjx2b2x1bWU+Mjk8L3ZvbHVtZT48bnVtYmVyPjY8L251bWJlcj48ZWRpdGlvbj4y

MDE3LzA0LzExPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3

b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFz

ZXMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzL3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ29nYXN0cmljIEp1bmN0aW9uLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlRlcnRpYXJ5IENh

cmUgQ2VudGVyczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48

a2V5d29yZD5keXNwaGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gKEVHSk9PKTwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24g

ZXNvcGhhZ2VhbCBwcmVzc3VyZSB0b3BvZ3JhcGh5IChIUkVQVCk8L2tleXdvcmQ+PC9rZXl3b3Jk

cz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1

Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yODM5

MzQzNzwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjExMTEvbm1vLjEzMDYxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8

L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pa2VrZTwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl

Y051bT4yMzQxPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzVdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM0MTwvcmVjLW51

bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3ZTl0

NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTMzOTM4NzQ5Ij4yMzQxPC9rZXk+PC9m

b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl

Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Pa2VrZSwgRi4gQy48L2F1dGhvcj48YXV0

aG9yPlJhamEsIFMuPC9hdXRob3I+PGF1dGhvcj5MeW5jaCwgSy4gTC48L2F1dGhvcj48YXV0aG9y

PkRoYWxsYSwgUy48L2F1dGhvcj48YXV0aG9yPk5hbmR3YW5pLCBNLjwvYXV0aG9yPjxhdXRob3I+

U3RlaW4sIEUuIE0uPC9hdXRob3I+PGF1dGhvcj5DaGFuZGVyIFJvbGFuZCwgQi48L2F1dGhvcj48

YXV0aG9yPktoYXNoYWIsIE0uIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRob3I+

PGF1dGhvcj5LdW1iaGFyaSwgVi48L2F1dGhvcj48YXV0aG9yPkFodWphLCBOLiBLLjwvYXV0aG9y

PjxhdXRob3I+Q2xhcmtlLCBKLiBPLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkRpdmlzaW9uIG9mIEhvc3BpdGFsIE1lZGljaW5lLCBUaGUgSm9obnMgSG9w

a2lucyBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQmFsdGltb3JlLCBNRCwgVVNBLiYj

eEQ7RGl2aXNpb24gb2YgR2FzdHJvZW50ZXJvbG9neSAmYW1wOyBIZXBhdG9sb2d5LCBFbW9yeSBV

bml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EsIFVTQS4mI3hEO0Rpdmlz

aW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3kgJmFtcDsgSGVwYXRvbG9neSwgVW5pdmVyc2l0eSBvZiBQ

ZW5uc3lsdmFuaWEgU2Nob29sIG9mIE1lZGljaW5lLCBQaGlsYWRlbHBoaWEsIFBBLCBVU0EuJiN4

RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFRoZSBKb2hu

cyBIb3BraW5zIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBCYWx0aW1vcmUsIE1ELCBV

U0EuJiN4RDtEaXZpc2lvbiBvZiBHYXN0cm9lbnRlcm9sb2d5ICZhbXA7IEhlcGF0b2xvZ3ksIFN0

YW5mb3JkIFVuaXZlcnNpdHkgU2Nob29sIG9mIE1lZGljaW5lLCBTdGFuZm9yZCwgQ0EsIFVTQS4m

I3hEO0RpdmlzaW9uIG9mIEdhc3Ryb2VudGVyb2xvZ3ksIFJveWFsIFByaW5jZSBBbGZyZWQgSG9z

cGl0YWwsIFN5ZG5leSwgTlNXLCBBdXN0cmFsaWEuPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0

bGU+V2hhdCBpcyB0aGUgY2xpbmljYWwgc2lnbmlmaWNhbmNlIG9mIGVzb3BoYWdvZ2FzdHJpYyBq

dW5jdGlvbiBvdXRmbG93IG9ic3RydWN0aW9uPyBldmFsdWF0aW9uIG9mIDYwIHBhdGllbnRzIGF0

IGEgdGVydGlhcnkgcmVmZXJyYWwgY2VudGVyPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPk5ldXJv

Z2FzdHJvZW50ZXJvbCBNb3RpbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FsdC10aXRsZT48L3Rp

dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OZXVyb2dhc3Ryb2VudGVyb2wgTW90aWw8L2Z1

bGwtdGl0bGU+PGFiYnItMT5OZXVyb2dhc3Ryb2VudGVyb2xvZ3kgYW5kIG1vdGlsaXR5IDogdGhl

IG9mZmljaWFsIGpvdXJuYWwgb2YgdGhlIEV1cm9wZWFuIEdhc3Ryb2ludGVzdGluYWwgTW90aWxp

dHkgU29jaWV0eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0

bGU+TmV1cm9nYXN0cm9lbnRlcm9sIE1vdGlsPC9mdWxsLXRpdGxlPjxhYmJyLTE+TmV1cm9nYXN0

cm9lbnRlcm9sb2d5IGFuZCBtb3RpbGl0eSA6IHRoZSBvZmZpY2lhbCBqb3VybmFsIG9mIHRoZSBF

dXJvcGVhbiBHYXN0cm9pbnRlc3RpbmFsIE1vdGlsaXR5IFNvY2lldHk8L2FiYnItMT48L2FsdC1w

ZXJpb2RpY2FsPjx2b2x1bWU+Mjk8L3ZvbHVtZT48bnVtYmVyPjY8L251bWJlcj48ZWRpdGlvbj4y

MDE3LzA0LzExPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3

b3JkPkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgRGlzZWFz

ZXMvY29tcGxpY2F0aW9ucy8qZGlhZ25vc2lzL3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ29nYXN0cmljIEp1bmN0aW9uLypwaHlzaW9wYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+

RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9r

ZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlRlcnRpYXJ5IENh

cmUgQ2VudGVyczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48

a2V5d29yZD5keXNwaGFnaWE8L2tleXdvcmQ+PGtleXdvcmQ+ZXNvcGhhZ29nYXN0cmljIG91dGZs

b3cgb2JzdHJ1Y3Rpb24gKEVHSk9PKTwva2V5d29yZD48a2V5d29yZD5oaWdoLXJlc29sdXRpb24g

ZXNvcGhhZ2VhbCBwcmVzc3VyZSB0b3BvZ3JhcGh5IChIUkVQVCk8L2tleXdvcmQ+PC9rZXl3b3Jk

cz48ZGF0ZXM+PHllYXI+MjAxNzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bjwvZGF0ZT48L3B1

Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEzNTAtMTkyNTwvaXNibj48YWNjZXNzaW9uLW51bT4yODM5

MzQzNzwvYWNjZXNzaW9uLW51bT48dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjExMTEvbm1vLjEzMDYxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFi

YXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8

L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+

ADDIN EN.CITE.DATA [5]. Figure 2 represents a proposed algorithm for the management of EGJOO.Choosing which treatment modality to apply in cases of functional EGJOO depends on patient’s factors (overall health condition and patient preference) and availability of center expertise. Botulinum toxin injection adds little time to endoscopy and is safe. Patients my experience chest pain after injection and, rarely, mediastinitis and allergic reaction to egg protein may develop. It is important to note that treatment efficacy of botulinum injection is limited to less than one year and may make subsequent myotomy more difficultPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TbWl0aDwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl

Y051bT4yMzY3PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzIxLCAyMl08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzY3PC9y

ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1

cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMxOTY4OTAiPjIzNjc8L2tl

eT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVm

LXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNtaXRoLCBDLiBELjwvYXV0aG9y

PjxhdXRob3I+U3RpdmFsLCBBLjwvYXV0aG9yPjxhdXRob3I+SG93ZWxsLCBELiBMLjwvYXV0aG9y

PjxhdXRob3I+U3dhZmZvcmQsIFYuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxh

dXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBTdXJnZXJ5LCBFbW9yeSBVbml2ZXJzaXR5IFNjaG9v

bCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EgMzAzMjIsIFVTQS4gY3NtaXQyN0BlbW9yeS5lZHU8

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5FbmRvc2NvcGljIHRoZXJhcHkgZm9yIGFjaGFs

YXNpYSBiZWZvcmUgSGVsbGVyIG15b3RvbXkgcmVzdWx0cyBpbiB3b3JzZSBvdXRjb21lcyB0aGFu

IGhlbGxlciBteW90b215IGFsb25lPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFubiBTdXJnPC9z

ZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Bbm5hbHMgb2Ygc3VyZ2VyeTwvYWx0LXRpdGxlPjwv

dGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFubiBTdXJnPC9mdWxsLXRpdGxlPjxhYmJy

LTE+QW5uYWxzIG9mIHN1cmdlcnk8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2Fs

PjxmdWxsLXRpdGxlPkFubiBTdXJnPC9mdWxsLXRpdGxlPjxhYmJyLTE+QW5uYWxzIG9mIHN1cmdl

cnk8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz41NzktODQ7IGRpc2N1c3Npb24gNTg0

LTY8L3BhZ2VzPjx2b2x1bWU+MjQzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+

MjAwNi8wNC8yNTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29y

ZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3Jk

PkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkNoaWxkPC9rZXl3b3JkPjxrZXl3

b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lhLypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlY3RvbXkvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+KkVzb3BoYWdvc2NvcHk8L2tleXdv

cmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5

d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3Jk

Pk11c2NsZSwgU21vb3RoL3N1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+UHJlb3BlcmF0aXZlIENh

cmU8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNjwveWVhcj48cHViLWRhdGVz

PjxkYXRlPk1heTwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAwMDMtNDkzMiAoUHJp

bnQpJiN4RDswMDAzLTQ5MzI8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTY2MzI5OTE8L2FjY2Vzc2lv

bi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzE1NzA1NTE8L2N1c3RvbTI+PGVsZWN0cm9u

aWMtcmVzb3VyY2UtbnVtPjEwLjEwOTcvMDEuc2xhLjAwMDAyMTc1MjQuNzU1MjkuMmQ8L2VsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUt

ZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRl

PjxDaXRlPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJlY051

bT4yMzY4PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4yMzY4PC9yZWMtbnVtYmVyPjxmb3Jl

aWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdlOXQ1YjU5NWRqcmZw

dHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMxOTcwNTkiPjIzNjg8L2tleT48L2ZvcmVpZ24ta2V5

cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1

dG9ycz48YXV0aG9ycz48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRob3I+PGF1dGhvcj5L

YWhyaWxhcywgUC4gSi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRk

cmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgRmVp

bmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBDaGljYWdvLCBJbGxpbm9pcyA2MDYxMS0yOTUxLCBV

U0EuIGotcGFuZG9sZmlub0Bub3J0aHdlc3Rlcm4uZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+UHJlc2VudGF0aW9uLCBkaWFnbm9zaXMsIGFuZCBtYW5hZ2VtZW50IG9mIGFjaGFsYXNp

YTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvc2Vj

b25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVw

YXRvbG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBB

bWVyaWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hbHQtdGl0bGU+PC90aXRs

ZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L2Z1

bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5

IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2Fu

IEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L3BlcmlvZGljYWw+PGFs

dC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9mdWxs

LXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRvbG9neSA6

IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBH

YXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48

cGFnZXM+ODg3LTk3PC9wYWdlcz48dm9sdW1lPjExPC92b2x1bWU+PG51bWJlcj44PC9udW1iZXI+

PGVkaXRpb24+MjAxMy8wMi8xMjwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2Vh

bCBBY2hhbGFzaWEvKmRpYWdub3Npcy9wYXRob2xvZ3kvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdv

cmQ+RXNvcGhhZ3VzLypwYXRob2xvZ3kvKnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29y

ZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+RWdqPC9rZXl3b3JkPjxrZXl3b3JkPkVwdDwva2V5

d29yZD48a2V5d29yZD5Icm08L2tleXdvcmQ+PGtleXdvcmQ+SXJwPC9rZXl3b3JkPjxrZXl3b3Jk

Pkxlczwva2V5d29yZD48a2V5d29yZD5Qb2VtPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwg

cHJlc3N1cmUgdG9wb2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVu

Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aGlnaC1yZXNvbHV0aW9uIG1hbm9tZXRyeTwva2V5d29y

ZD48a2V5d29yZD5pbnRlZ3JhdGVkIHJlbGF4YXRpb24gcHJlc3N1cmU8L2tleXdvcmQ+PGtleXdv

cmQ+bG93ZXIgZXNvcGhhZ2VhbCBzcGhpbmN0ZXI8L2tleXdvcmQ+PGtleXdvcmQ+cGVyIG9yYWwg

ZW5kb3Njb3BpYyBteW90b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTM8

L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNi

bj4xNTQyLTM1NjU8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjMzOTU2OTk8L2FjY2Vzc2lvbi1udW0+

PHVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDE2L2ouY2doLjIwMTMu

MDEuMDMyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVy

Pk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TbWl0aDwvQXV0aG9yPjxZZWFyPjIwMDY8L1llYXI+PFJl

Y051bT4yMzY3PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzIxLCAyMl08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzY3PC9y

ZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1

cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMxOTY4OTAiPjIzNjc8L2tl

eT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVm

LXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlNtaXRoLCBDLiBELjwvYXV0aG9y

PjxhdXRob3I+U3RpdmFsLCBBLjwvYXV0aG9yPjxhdXRob3I+SG93ZWxsLCBELiBMLjwvYXV0aG9y

PjxhdXRob3I+U3dhZmZvcmQsIFYuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxh

dXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBTdXJnZXJ5LCBFbW9yeSBVbml2ZXJzaXR5IFNjaG9v

bCBvZiBNZWRpY2luZSwgQXRsYW50YSwgR0EgMzAzMjIsIFVTQS4gY3NtaXQyN0BlbW9yeS5lZHU8

L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5FbmRvc2NvcGljIHRoZXJhcHkgZm9yIGFjaGFs

YXNpYSBiZWZvcmUgSGVsbGVyIG15b3RvbXkgcmVzdWx0cyBpbiB3b3JzZSBvdXRjb21lcyB0aGFu

IGhlbGxlciBteW90b215IGFsb25lPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkFubiBTdXJnPC9z

ZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Bbm5hbHMgb2Ygc3VyZ2VyeTwvYWx0LXRpdGxlPjwv

dGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFubiBTdXJnPC9mdWxsLXRpdGxlPjxhYmJy

LTE+QW5uYWxzIG9mIHN1cmdlcnk8L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2Fs

PjxmdWxsLXRpdGxlPkFubiBTdXJnPC9mdWxsLXRpdGxlPjxhYmJyLTE+QW5uYWxzIG9mIHN1cmdl

cnk8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz41NzktODQ7IGRpc2N1c3Npb24gNTg0

LTY8L3BhZ2VzPjx2b2x1bWU+MjQzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+

MjAwNi8wNC8yNTwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWRvbGVzY2VudDwva2V5d29y

ZD48a2V5d29yZD5BZHVsdDwva2V5d29yZD48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3b3Jk

PkFnZWQsIDgwIGFuZCBvdmVyPC9rZXl3b3JkPjxrZXl3b3JkPkNoaWxkPC9rZXl3b3JkPjxrZXl3

b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lhLypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3Bo

YWdlY3RvbXkvKm1ldGhvZHM8L2tleXdvcmQ+PGtleXdvcmQ+KkVzb3BoYWdvc2NvcHk8L2tleXdv

cmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5

d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3Jk

Pk11c2NsZSwgU21vb3RoL3N1cmdlcnk8L2tleXdvcmQ+PGtleXdvcmQ+UHJlb3BlcmF0aXZlIENh

cmU8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNjwveWVhcj48cHViLWRhdGVz

PjxkYXRlPk1heTwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjAwMDMtNDkzMiAoUHJp

bnQpJiN4RDswMDAzLTQ5MzI8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTY2MzI5OTE8L2FjY2Vzc2lv

bi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzE1NzA1NTE8L2N1c3RvbTI+PGVsZWN0cm9u

aWMtcmVzb3VyY2UtbnVtPjEwLjEwOTcvMDEuc2xhLjAwMDAyMTc1MjQuNzU1MjkuMmQ8L2VsZWN0

cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1vdGUt

ZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRl

PjxDaXRlPjxBdXRob3I+UGFuZG9sZmlubzwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJlY051

bT4yMzY4PC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4yMzY4PC9yZWMtbnVtYmVyPjxmb3Jl

aWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5dmQ1cjdlOXQ1YjU5NWRqcmZw

dHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMxOTcwNTkiPjIzNjg8L2tleT48L2ZvcmVpZ24ta2V5

cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1

dG9ycz48YXV0aG9ycz48YXV0aG9yPlBhbmRvbGZpbm8sIEouIEUuPC9hdXRob3I+PGF1dGhvcj5L

YWhyaWxhcywgUC4gSi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRk

cmVzcz5EZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgRmVp

bmJlcmcgU2Nob29sIG9mIE1lZGljaW5lLCBDaGljYWdvLCBJbGxpbm9pcyA2MDYxMS0yOTUxLCBV

U0EuIGotcGFuZG9sZmlub0Bub3J0aHdlc3Rlcm4uZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+UHJlc2VudGF0aW9uLCBkaWFnbm9zaXMsIGFuZCBtYW5hZ2VtZW50IG9mIGFjaGFsYXNp

YTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DbGluIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvc2Vj

b25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVw

YXRvbG9neSA6IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBB

bWVyaWNhbiBHYXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hbHQtdGl0bGU+PC90aXRs

ZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+Q2xpbiBHYXN0cm9lbnRlcm9sIEhlcGF0b2w8L2Z1

bGwtdGl0bGU+PGFiYnItMT5DbGluaWNhbCBnYXN0cm9lbnRlcm9sb2d5IGFuZCBoZXBhdG9sb2d5

IDogdGhlIG9mZmljaWFsIGNsaW5pY2FsIHByYWN0aWNlIGpvdXJuYWwgb2YgdGhlIEFtZXJpY2Fu

IEdhc3Ryb2VudGVyb2xvZ2ljYWwgQXNzb2NpYXRpb248L2FiYnItMT48L3BlcmlvZGljYWw+PGFs

dC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkNsaW4gR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9mdWxs

LXRpdGxlPjxhYmJyLTE+Q2xpbmljYWwgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRvbG9neSA6

IHRoZSBvZmZpY2lhbCBjbGluaWNhbCBwcmFjdGljZSBqb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBH

YXN0cm9lbnRlcm9sb2dpY2FsIEFzc29jaWF0aW9uPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48

cGFnZXM+ODg3LTk3PC9wYWdlcz48dm9sdW1lPjExPC92b2x1bWU+PG51bWJlcj44PC9udW1iZXI+

PGVkaXRpb24+MjAxMy8wMi8xMjwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2Vh

bCBBY2hhbGFzaWEvKmRpYWdub3Npcy9wYXRob2xvZ3kvKnRoZXJhcHk8L2tleXdvcmQ+PGtleXdv

cmQ+RXNvcGhhZ3VzLypwYXRob2xvZ3kvKnBoeXNpb3BhdGhvbG9neTwva2V5d29yZD48a2V5d29y

ZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+RWdqPC9rZXl3b3JkPjxrZXl3b3JkPkVwdDwva2V5

d29yZD48a2V5d29yZD5Icm08L2tleXdvcmQ+PGtleXdvcmQ+SXJwPC9rZXl3b3JkPjxrZXl3b3Jk

Pkxlczwva2V5d29yZD48a2V5d29yZD5Qb2VtPC9rZXl3b3JkPjxrZXl3b3JkPmVzb3BoYWdlYWwg

cHJlc3N1cmUgdG9wb2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5lc29waGFnb2dhc3RyaWMganVu

Y3Rpb248L2tleXdvcmQ+PGtleXdvcmQ+aGlnaC1yZXNvbHV0aW9uIG1hbm9tZXRyeTwva2V5d29y

ZD48a2V5d29yZD5pbnRlZ3JhdGVkIHJlbGF4YXRpb24gcHJlc3N1cmU8L2tleXdvcmQ+PGtleXdv

cmQ+bG93ZXIgZXNvcGhhZ2VhbCBzcGhpbmN0ZXI8L2tleXdvcmQ+PGtleXdvcmQ+cGVyIG9yYWwg

ZW5kb3Njb3BpYyBteW90b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTM8

L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNi

bj4xNTQyLTM1NjU8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjMzOTU2OTk8L2FjY2Vzc2lvbi1udW0+

PHVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDE2L2ouY2doLjIwMTMu

MDEuMDMyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVy

Pk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA [21,22]. Therefore, botulinum toxin injection should be reserved for patients who are poor surgical candidates or unclear diagnosis. Pneumatic dilation has been used for the treatment of achalasia and can be considered in cases of functional EGJOO with persistent symptoms. The initial approach is to start with 30-mm dilator with subsequent dilation using 35-mm dilator (graded dilation) in 2-4 wk if initial dilation was insufficient. When performed by experienced operator following conservative approach, the risk of perforation with PD is < 1%PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MeW5jaDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl

Y051bT4yMzY5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzIzXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNjk8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5

dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTU0MzI4MzkyMSI+MjM2OTwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+THluY2gsIEsuIEwuPC9hdXRob3I+PGF1

dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+SG93ZGVuLCBDLiBXLjwvYXV0

aG9yPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0

b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29s

IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgQ2hpY2FnbywgSWxsaW5vaXMg

NjA2MTEsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5NYWpvciBjb21wbGljYXRp

b25zIG9mIHBuZXVtYXRpYyBkaWxhdGlvbiBhbmQgSGVsbGVyIG15b3RvbXkgZm9yIGFjaGFsYXNp

YTogc2luZ2xlLWNlbnRlciBleHBlcmllbmNlIGFuZCBzeXN0ZW1hdGljIHJldmlldyBvZiB0aGUg

bGl0ZXJhdHVyZTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2Vu

dGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBK

IEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBv

ZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48

ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1l

cmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNh

bD48cGFnZXM+MTgxNy0yNTwvcGFnZXM+PHZvbHVtZT4xMDc8L3ZvbHVtZT48bnVtYmVyPjEyPC9u

dW1iZXI+PGVkaXRpb24+MjAxMi8xMC8wNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1

bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5EaWxhdGF0aW9uLyph

ZHZlcnNlIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvc3Vy

Z2VyeS8qdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIFBlcmZvcmF0aW9uLypl

cGlkZW1pb2xvZ3kvKmV0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdvcGxhc3R5Lyph

ZHZlcnNlIGVmZmVjdHMvaW5zdHJ1bWVudGF0aW9uLyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3Jk

PkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkxhcGFy

b3Njb3B5PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWVkaWNhbCBS

ZWNvcmRzPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk5v

cnRod2VzdGVybiBVbml0ZWQgU3RhdGVzL2VwaWRlbWlvbG9neTwva2V5d29yZD48a2V5d29yZD5S

ZXRyb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+U3VydmV5cyBhbmQgUXVlc3Rp

b25uYWlyZXM8L2tleXdvcmQ+PGtleXdvcmQ+VGVsZXBob25lPC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTI8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5EZWM8L2RhdGU+PC9wdWIt

ZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjMwMzI5

Nzg8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzM4MDgxNjU8L2N1c3Rv

bTI+PGN1c3RvbTY+TklITVM1MTY5Njg8L2N1c3RvbTY+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjEwMzgvYWpnLjIwMTIuMzMyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRh

dGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5l

bmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MeW5jaDwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJl

Y051bT4yMzY5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzIzXTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNjk8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5

dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTU0MzI4MzkyMSI+MjM2OTwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+THluY2gsIEsuIEwuPC9hdXRob3I+PGF1

dGhvcj5QYW5kb2xmaW5vLCBKLiBFLjwvYXV0aG9yPjxhdXRob3I+SG93ZGVuLCBDLiBXLjwvYXV0

aG9yPjxhdXRob3I+S2FocmlsYXMsIFAuIEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0

b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBNZWRpY2luZSwgRmVpbmJlcmcgU2Nob29s

IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4gVW5pdmVyc2l0eSwgQ2hpY2FnbywgSWxsaW5vaXMg

NjA2MTEsIFVTQS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5NYWpvciBjb21wbGljYXRp

b25zIG9mIHBuZXVtYXRpYyBkaWxhdGlvbiBhbmQgSGVsbGVyIG15b3RvbXkgZm9yIGFjaGFsYXNp

YTogc2luZ2xlLWNlbnRlciBleHBlcmllbmNlIGFuZCBzeXN0ZW1hdGljIHJldmlldyBvZiB0aGUg

bGl0ZXJhdHVyZTwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L3Nl

Y29uZGFyeS10aXRsZT48YWx0LXRpdGxlPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2Vu

dGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5BbSBK

IEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1lcmljYW4gam91cm5hbCBv

ZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48

ZnVsbC10aXRsZT5BbSBKIEdhc3Ryb2VudGVyb2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgQW1l

cmljYW4gam91cm5hbCBvZiBnYXN0cm9lbnRlcm9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNh

bD48cGFnZXM+MTgxNy0yNTwvcGFnZXM+PHZvbHVtZT4xMDc8L3ZvbHVtZT48bnVtYmVyPjEyPC9u

dW1iZXI+PGVkaXRpb24+MjAxMi8xMC8wNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1

bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5EaWxhdGF0aW9uLyph

ZHZlcnNlIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvc3Vy

Z2VyeS8qdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIFBlcmZvcmF0aW9uLypl

cGlkZW1pb2xvZ3kvKmV0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdvcGxhc3R5Lyph

ZHZlcnNlIGVmZmVjdHMvaW5zdHJ1bWVudGF0aW9uLyptZXRob2RzPC9rZXl3b3JkPjxrZXl3b3Jk

PkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkxhcGFy

b3Njb3B5PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+TWVkaWNhbCBS

ZWNvcmRzPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk5v

cnRod2VzdGVybiBVbml0ZWQgU3RhdGVzL2VwaWRlbWlvbG9neTwva2V5d29yZD48a2V5d29yZD5S

ZXRyb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+U3VydmV5cyBhbmQgUXVlc3Rp

b25uYWlyZXM8L2tleXdvcmQ+PGtleXdvcmQ+VGVsZXBob25lPC9rZXl3b3JkPjwva2V5d29yZHM+

PGRhdGVzPjx5ZWFyPjIwMTI8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5EZWM8L2RhdGU+PC9wdWIt

ZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjMwMzI5

Nzg8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxjdXN0b20yPlBNQzM4MDgxNjU8L2N1c3Rv

bTI+PGN1c3RvbTY+TklITVM1MTY5Njg8L2N1c3RvbTY+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjEwMzgvYWpnLjIwMTIuMzMyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRh

dGFiYXNlLXByb3ZpZGVyPk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5l

bmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA [23]. Graded pneumatic dilation has been shown to be non-inferior to surgical Heller myotomy in term of long-term efficacyPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb2Vja3hzdGFlbnM8L0F1dGhvcj48WWVhcj4yMDExPC9Z

ZWFyPjxSZWNOdW0+MjM3MDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJz

Y3JpcHQiPlsyNF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzcw

PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5

dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMzNjk1MTMiPjIzNzA8

L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv

cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJvZWNreHN0YWVucywgRy4g

RS48L2F1dGhvcj48YXV0aG9yPkFubmVzZSwgVi48L2F1dGhvcj48YXV0aG9yPmRlcyBWYXJhbm5l

cywgUy4gQi48L2F1dGhvcj48YXV0aG9yPkNoYXVzc2FkZSwgUy48L2F1dGhvcj48YXV0aG9yPkNv

c3RhbnRpbmksIE0uPC9hdXRob3I+PGF1dGhvcj5DdXR0aXR0YSwgQS48L2F1dGhvcj48YXV0aG9y

PkVsaXphbGRlLCBKLiBJLjwvYXV0aG9yPjxhdXRob3I+RnVtYWdhbGxpLCBVLjwvYXV0aG9yPjxh

dXRob3I+R2F1ZHJpYywgTS48L2F1dGhvcj48YXV0aG9yPlJvaG9mLCBXLiBPLjwvYXV0aG9yPjxh

dXRob3I+U21vdXQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5UYWNrLCBKLjwvYXV0aG9yPjxhdXRo

b3I+WndpbmRlcm1hbiwgQS4gSC48L2F1dGhvcj48YXV0aG9yPlphbmlub3R0bywgRy48L2F1dGhv

cj48YXV0aG9yPkJ1c2NoLCBPLiBSLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkFjYWRlbWljIE1lZGljYWwgQ2VudGVyLCBBbXN0ZXJkYW0sIFRoZSBOZXRo

ZXJsYW5kcy4gZ3V5LmJvZWNreHN0YWVuc0BtZWQua3VsZXV2ZW4uYmU8L2F1dGgtYWRkcmVzcz48

dGl0bGVzPjx0aXRsZT5QbmV1bWF0aWMgZGlsYXRpb24gdmVyc3VzIGxhcGFyb3Njb3BpYyBIZWxs

ZXImYXBvcztzIG15b3RvbXkgZm9yIGlkaW9wYXRoaWMgYWNoYWxhc2lhPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPk4gRW5nbCBKIE1lZDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+VGhlIE5l

dyBFbmdsYW5kIGpvdXJuYWwgb2YgbWVkaWNpbmU8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5OIEVuZ2wgSiBNZWQ8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgTmV3

IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBl

cmlvZGljYWw+PGZ1bGwtdGl0bGU+TiBFbmdsIEogTWVkPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhl

IE5ldyBFbmdsYW5kIGpvdXJuYWwgb2YgbWVkaWNpbmU8L2FiYnItMT48L2FsdC1wZXJpb2RpY2Fs

PjxwYWdlcz4xODA3LTE2PC9wYWdlcz48dm9sdW1lPjM2NDwvdm9sdW1lPjxudW1iZXI+MTk8L251

bWJlcj48ZWRpdGlvbj4yMDExLzA1LzEzPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVs

dDwva2V5d29yZD48a2V5d29yZD4qQ2F0aGV0ZXJpemF0aW9uL2FkdmVyc2UgZWZmZWN0czwva2V5

d29yZD48a2V5d29yZD5DaGktU3F1YXJlIERpc3RyaWJ1dGlvbjwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIEFjaGFsYXNpYS8qc3VyZ2VyeS8qdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIFBlcmZvcmF0aW9uL2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdl

YWwgU3BoaW5jdGVyLCBMb3dlci9zdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy9p

bmp1cmllczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Rm9sbG93

LVVwIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+KkZ1bmRvcGxpY2F0aW9uL21ldGhvZHM8L2tl

eXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkludGVudGlvbiB0byBUcmVh

dCBBbmFseXNpczwva2V5d29yZD48a2V5d29yZD5LYXBsYW4tTWVpZXIgRXN0aW1hdGU8L2tleXdv

cmQ+PGtleXdvcmQ+KkxhcGFyb3Njb3B5L2FkdmVyc2UgZWZmZWN0czwva2V5d29yZD48a2V5d29y

ZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlJl

dHJlYXRtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29y

ZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDEx

PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+TWF5IDEyPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MDAyOC00NzkzPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIxNTYxMzQ2PC9hY2Nlc3Npb24t

bnVtPjx1cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA1Ni9ORUpNb2Ex

MDEwNTAyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVy

Pk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb2Vja3hzdGFlbnM8L0F1dGhvcj48WWVhcj4yMDExPC9Z

ZWFyPjxSZWNOdW0+MjM3MDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJz

Y3JpcHQiPlsyNF08L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzcw

PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5

dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDMzNjk1MTMiPjIzNzA8

L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv

cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkJvZWNreHN0YWVucywgRy4g

RS48L2F1dGhvcj48YXV0aG9yPkFubmVzZSwgVi48L2F1dGhvcj48YXV0aG9yPmRlcyBWYXJhbm5l

cywgUy4gQi48L2F1dGhvcj48YXV0aG9yPkNoYXVzc2FkZSwgUy48L2F1dGhvcj48YXV0aG9yPkNv

c3RhbnRpbmksIE0uPC9hdXRob3I+PGF1dGhvcj5DdXR0aXR0YSwgQS48L2F1dGhvcj48YXV0aG9y

PkVsaXphbGRlLCBKLiBJLjwvYXV0aG9yPjxhdXRob3I+RnVtYWdhbGxpLCBVLjwvYXV0aG9yPjxh

dXRob3I+R2F1ZHJpYywgTS48L2F1dGhvcj48YXV0aG9yPlJvaG9mLCBXLiBPLjwvYXV0aG9yPjxh

dXRob3I+U21vdXQsIEEuIEouPC9hdXRob3I+PGF1dGhvcj5UYWNrLCBKLjwvYXV0aG9yPjxhdXRo

b3I+WndpbmRlcm1hbiwgQS4gSC48L2F1dGhvcj48YXV0aG9yPlphbmlub3R0bywgRy48L2F1dGhv

cj48YXV0aG9yPkJ1c2NoLCBPLiBSLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48

YXV0aC1hZGRyZXNzPkFjYWRlbWljIE1lZGljYWwgQ2VudGVyLCBBbXN0ZXJkYW0sIFRoZSBOZXRo

ZXJsYW5kcy4gZ3V5LmJvZWNreHN0YWVuc0BtZWQua3VsZXV2ZW4uYmU8L2F1dGgtYWRkcmVzcz48

dGl0bGVzPjx0aXRsZT5QbmV1bWF0aWMgZGlsYXRpb24gdmVyc3VzIGxhcGFyb3Njb3BpYyBIZWxs

ZXImYXBvcztzIG15b3RvbXkgZm9yIGlkaW9wYXRoaWMgYWNoYWxhc2lhPC90aXRsZT48c2Vjb25k

YXJ5LXRpdGxlPk4gRW5nbCBKIE1lZDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQtdGl0bGU+VGhlIE5l

dyBFbmdsYW5kIGpvdXJuYWwgb2YgbWVkaWNpbmU8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5OIEVuZ2wgSiBNZWQ8L2Z1bGwtdGl0bGU+PGFiYnItMT5UaGUgTmV3

IEVuZ2xhbmQgam91cm5hbCBvZiBtZWRpY2luZTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBl

cmlvZGljYWw+PGZ1bGwtdGl0bGU+TiBFbmdsIEogTWVkPC9mdWxsLXRpdGxlPjxhYmJyLTE+VGhl

IE5ldyBFbmdsYW5kIGpvdXJuYWwgb2YgbWVkaWNpbmU8L2FiYnItMT48L2FsdC1wZXJpb2RpY2Fs

PjxwYWdlcz4xODA3LTE2PC9wYWdlcz48dm9sdW1lPjM2NDwvdm9sdW1lPjxudW1iZXI+MTk8L251

bWJlcj48ZWRpdGlvbj4yMDExLzA1LzEzPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZHVs

dDwva2V5d29yZD48a2V5d29yZD4qQ2F0aGV0ZXJpemF0aW9uL2FkdmVyc2UgZWZmZWN0czwva2V5

d29yZD48a2V5d29yZD5DaGktU3F1YXJlIERpc3RyaWJ1dGlvbjwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIEFjaGFsYXNpYS8qc3VyZ2VyeS8qdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5F

c29waGFnZWFsIFBlcmZvcmF0aW9uL2V0aW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdl

YWwgU3BoaW5jdGVyLCBMb3dlci9zdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWd1cy9p

bmp1cmllczwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+Rm9sbG93

LVVwIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+KkZ1bmRvcGxpY2F0aW9uL21ldGhvZHM8L2tl

eXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPkludGVudGlvbiB0byBUcmVh

dCBBbmFseXNpczwva2V5d29yZD48a2V5d29yZD5LYXBsYW4tTWVpZXIgRXN0aW1hdGU8L2tleXdv

cmQ+PGtleXdvcmQ+KkxhcGFyb3Njb3B5L2FkdmVyc2UgZWZmZWN0czwva2V5d29yZD48a2V5d29y

ZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlJl

dHJlYXRtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29y

ZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDEx

PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+TWF5IDEyPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MDAyOC00NzkzPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIxNTYxMzQ2PC9hY2Nlc3Npb24t

bnVtPjx1cmxzPjwvdXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+MTAuMTA1Ni9ORUpNb2Ex

MDEwNTAyPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48cmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVy

Pk5MTTwvcmVtb3RlLWRhdGFiYXNlLXByb3ZpZGVyPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA [24]. POEM is a novel technique that was shown to be a safe and effective modality (> 90% success rate) for the treatment of achalasiaPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Jbm91ZTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl

Y051bT4yMzczPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzI2XTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNzM8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5

dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTU0MzY4ODQ1MSI+MjM3Mzwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+SW5vdWUsIEguPC9hdXRob3I+PGF1dGhv

cj5TYXRvLCBILjwvYXV0aG9yPjxhdXRob3I+SWtlZGEsIEguPC9hdXRob3I+PGF1dGhvcj5Pbmlt

YXJ1LCBNLjwvYXV0aG9yPjxhdXRob3I+U2F0bywgQy48L2F1dGhvcj48YXV0aG9yPk1pbmFtaSwg

SC48L2F1dGhvcj48YXV0aG9yPllva29taWNoaSwgSC48L2F1dGhvcj48YXV0aG9yPktvYmF5YXNo

aSwgWS48L2F1dGhvcj48YXV0aG9yPkdyaW1lcywgSy4gTC48L2F1dGhvcj48YXV0aG9yPkt1ZG8s

IFMuIEUuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGln

ZXN0aXZlIERpc2Vhc2UgQ2VudGVyLCBTaG93YSBVbml2ZXJzaXR5LCBOb3J0aGVybiBZb2tvaGFt

YSBIb3NwaXRhbCwgWW9rb2hhbWEsIEphcGFuLiBFbGVjdHJvbmljIGFkZHJlc3M6IGhhcnVpbm91

ZUB5YWhvby5jby5qcC4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgU2hvd2EgVW5pdmVy

c2l0eSwgTm9ydGhlcm4gWW9rb2hhbWEgSG9zcGl0YWwsIFlva29oYW1hLCBKYXBhbi4mI3hEO0Rp

dmlzaW9uIG9mIE1lZGljaW5lLCBHcmFkdWF0ZSBTY2hvb2wgRGVwYXJ0bWVudCBvZiBJbnRlcmRp

c2NpcGxpbmFyeSBSZXNlYXJjaCwgVW5pdmVyc2l0eSBvZiBZYW1hbmFzaGksIFlhbWFuYXNoaSwg

SmFwYW4uJiN4RDtLb2JheWFzaGkgSW50ZXJuYWwgTWVkaWNpbmUgQ2xpbmljLCBLb2JlLCBKYXBh

bi4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgU2hvd2EgVW5pdmVyc2l0eSwgS290byBU

b3lvc3UgSG9zcGl0YWwsIFRva3lvLCBKYXBhbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5QZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXk6IEEgU2VyaWVzIG9mIDUwMCBQYXRpZW50czwv

dGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIEFtIENvbGwgU3VyZzwvc2Vjb25kYXJ5LXRpdGxlPjxh

bHQtdGl0bGU+Sm91cm5hbCBvZiB0aGUgQW1lcmljYW4gQ29sbGVnZSBvZiBTdXJnZW9uczwvYWx0

LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQW0gQ29sbCBTdXJnPC9m

dWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiB0aGUgQW1lcmljYW4gQ29sbGVnZSBvZiBTdXJn

ZW9uczwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBB

bSBDb2xsIFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBD

b2xsZWdlIG9mIFN1cmdlb25zPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjU2LTY0

PC9wYWdlcz48dm9sdW1lPjIyMTwvdm9sdW1lPjxudW1iZXI+MjwvbnVtYmVyPjxlZGl0aW9uPjIw

MTUvMDcvMjU8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5B

Z2VkLCA4MCBhbmQgb3Zlcjwva2V5d29yZD48a2V5d29yZD5DaGlsZDwva2V5d29yZD48a2V5d29y

ZD5DaGlsZCwgUHJlc2Nob29sPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lh

LypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgU3BoaW5jdGVyLCBMb3dlci8q

c3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Njb3B5LyptZXRob2RzPC9rZXl3b3Jk

PjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5Gb2xsb3ctVXAgU3R1ZGllczwva2V5

d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5

d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Qb3N0b3BlcmF0aXZlIENvbXBsaWNh

dGlvbnM8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdvcmQ+PGtleXdv

cmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNTwveWVh

cj48cHViLWRhdGVzPjxkYXRlPkF1ZzwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEw

NzItNzUxNTwvaXNibj48YWNjZXNzaW9uLW51bT4yNjIwNjYzNDwvYWNjZXNzaW9uLW51bT48dXJs

cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5qYW1jb2xsc3VyZy4y

MDE1LjAzLjA1NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92

aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFn

ZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Jbm91ZTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl

Y051bT4yMzczPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlwdCI+

WzI2XTwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjIzNzM8L3JlYy1u

dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSI1MHd4ZHB6ZDl2ZDVyN2U5

dDViNTk1ZGpyZnB0dHJ4dzlhdnAiIHRpbWVzdGFtcD0iMTU0MzY4ODQ1MSI+MjM3Mzwva2V5Pjwv

Zm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlw

ZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+SW5vdWUsIEguPC9hdXRob3I+PGF1dGhv

cj5TYXRvLCBILjwvYXV0aG9yPjxhdXRob3I+SWtlZGEsIEguPC9hdXRob3I+PGF1dGhvcj5Pbmlt

YXJ1LCBNLjwvYXV0aG9yPjxhdXRob3I+U2F0bywgQy48L2F1dGhvcj48YXV0aG9yPk1pbmFtaSwg

SC48L2F1dGhvcj48YXV0aG9yPllva29taWNoaSwgSC48L2F1dGhvcj48YXV0aG9yPktvYmF5YXNo

aSwgWS48L2F1dGhvcj48YXV0aG9yPkdyaW1lcywgSy4gTC48L2F1dGhvcj48YXV0aG9yPkt1ZG8s

IFMuIEUuPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGln

ZXN0aXZlIERpc2Vhc2UgQ2VudGVyLCBTaG93YSBVbml2ZXJzaXR5LCBOb3J0aGVybiBZb2tvaGFt

YSBIb3NwaXRhbCwgWW9rb2hhbWEsIEphcGFuLiBFbGVjdHJvbmljIGFkZHJlc3M6IGhhcnVpbm91

ZUB5YWhvby5jby5qcC4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgU2hvd2EgVW5pdmVy

c2l0eSwgTm9ydGhlcm4gWW9rb2hhbWEgSG9zcGl0YWwsIFlva29oYW1hLCBKYXBhbi4mI3hEO0Rp

dmlzaW9uIG9mIE1lZGljaW5lLCBHcmFkdWF0ZSBTY2hvb2wgRGVwYXJ0bWVudCBvZiBJbnRlcmRp

c2NpcGxpbmFyeSBSZXNlYXJjaCwgVW5pdmVyc2l0eSBvZiBZYW1hbmFzaGksIFlhbWFuYXNoaSwg

SmFwYW4uJiN4RDtLb2JheWFzaGkgSW50ZXJuYWwgTWVkaWNpbmUgQ2xpbmljLCBLb2JlLCBKYXBh

bi4mI3hEO0RpZ2VzdGl2ZSBEaXNlYXNlIENlbnRlciwgU2hvd2EgVW5pdmVyc2l0eSwgS290byBU

b3lvc3UgSG9zcGl0YWwsIFRva3lvLCBKYXBhbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRs

ZT5QZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXk6IEEgU2VyaWVzIG9mIDUwMCBQYXRpZW50czwv

dGl0bGU+PHNlY29uZGFyeS10aXRsZT5KIEFtIENvbGwgU3VyZzwvc2Vjb25kYXJ5LXRpdGxlPjxh

bHQtdGl0bGU+Sm91cm5hbCBvZiB0aGUgQW1lcmljYW4gQ29sbGVnZSBvZiBTdXJnZW9uczwvYWx0

LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkogQW0gQ29sbCBTdXJnPC9m

dWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiB0aGUgQW1lcmljYW4gQ29sbGVnZSBvZiBTdXJn

ZW9uczwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBB

bSBDb2xsIFN1cmc8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBD

b2xsZWdlIG9mIFN1cmdlb25zPC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+MjU2LTY0

PC9wYWdlcz48dm9sdW1lPjIyMTwvdm9sdW1lPjxudW1iZXI+MjwvbnVtYmVyPjxlZGl0aW9uPjIw

MTUvMDcvMjU8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+

PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdvcmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5B

Z2VkLCA4MCBhbmQgb3Zlcjwva2V5d29yZD48a2V5d29yZD5DaGlsZDwva2V5d29yZD48a2V5d29y

ZD5DaGlsZCwgUHJlc2Nob29sPC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgQWNoYWxhc2lh

LypzdXJnZXJ5PC9rZXl3b3JkPjxrZXl3b3JkPkVzb3BoYWdlYWwgU3BoaW5jdGVyLCBMb3dlci8q

c3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Njb3B5LyptZXRob2RzPC9rZXl3b3Jk

PjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5Gb2xsb3ctVXAgU3R1ZGllczwva2V5

d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+TWFsZTwva2V5d29yZD48a2V5

d29yZD5NaWRkbGUgQWdlZDwva2V5d29yZD48a2V5d29yZD5Qb3N0b3BlcmF0aXZlIENvbXBsaWNh

dGlvbnM8L2tleXdvcmQ+PGtleXdvcmQ+VHJlYXRtZW50IE91dGNvbWU8L2tleXdvcmQ+PGtleXdv

cmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAxNTwveWVh

cj48cHViLWRhdGVzPjxkYXRlPkF1ZzwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEw

NzItNzUxNTwvaXNibj48YWNjZXNzaW9uLW51bT4yNjIwNjYzNDwvYWNjZXNzaW9uLW51bT48dXJs

cz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5qYW1jb2xsc3VyZy4y

MDE1LjAzLjA1NzwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92

aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFn

ZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==

ADDIN EN.CITE.DATA [25,26]. However, post-POEM reflux is a major concern and is frequently seenPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzcyPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzhdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM3MjwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTQzNjc5NTY1Ij4yMzcyPC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhv

cj48YXV0aG9yPkthdHprYSwgRC48L2F1dGhvcj48YXV0aG9yPlJpY2h0ZXIsIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGlj

aW5lLCBDaGljYWdvLCBJbGxpbm9pcy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFzQG5v

cnRod2VzdGVybi5lZHUuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4g

VW5pdmVyc2l0eSBGZWluYmVyZyBTY2hvb2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlub2lz

LjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNsaW5pY2FsIFByYWN0aWNlIFVwZGF0ZTog

VGhlIFVzZSBvZiBQZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXkgaW4gQWNoYWxhc2lhOiBFeHBl

cnQgUmV2aWV3IGFuZCBCZXN0IFByYWN0aWNlIEFkdmljZSBGcm9tIHRoZSBBR0EgSW5zdGl0dXRl

PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L3NlY29uZGFyeS10aXRs

ZT48YWx0LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5HYXN0cm9lbnRlcm9sb2d5PC9mdWxsLXRpdGxlPjxhYmJyLTE+R2Fz

dHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+R2FzdHJvZW50ZXJvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkdhc3Ryb2VudGVyb2xv

Z3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjA1LTEyMTE8L3BhZ2VzPjx2b2x1

bWU+MTUzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxNy8xMC8xMTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvZGlhZ25vc2lzL3Bo

eXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnaXRpcywgUGVw

dGljL2RydWcgdGhlcmFweS9ldGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Njb3B5

L2FkdmVyc2UgZWZmZWN0cy9tZXRob2RzLypzdGFuZGFyZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ3VzL3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8

L2tleXdvcmQ+PGtleXdvcmQ+TGFwYXJvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vdXRoPC9r

ZXl3b3JkPjxrZXl3b3JkPk5hdHVyYWwgT3JpZmljZSBFbmRvc2NvcGljIFN1cmdlcnkvYWR2ZXJz

ZSBlZmZlY3RzL21ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5QYXRpZW50IFNl

bGVjdGlvbjwva2V5d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9rZXl3

b3JkPjxrZXl3b3JkPlByb3RvbiBQdW1wIEluaGliaXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9rZXl3

b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0

Y29tZTwva2V5d29yZD48a2V5d29yZD4qQWNoYWxhc2lhPC9rZXl3b3JkPjxrZXl3b3JkPipFc29w

aGFnZWFsIE1vdGlsaXR5IERpc29yZGVyczwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNvbHV0

aW9uIE1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD4qUGVyLU9yYWwgRW5kb3Njb3BpYyBNeW90

b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDE2LTUwODU8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjg5ODkwNTk8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxj

dXN0b20yPlBNQzU2NzAwMTM8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTMxMTk8L2N1c3RvbTY+

PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwNTMvai5nYXN0cm8uMjAxNy4xMC4wMDE8L2Vs

ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1v

dGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9D

aXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWhyaWxhczwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+

PFJlY051bT4yMzcyPC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBlcnNjcmlw

dCI+WzhdPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MjM3MjwvcmVj

LW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9IjUwd3hkcHpkOXZkNXI3

ZTl0NWI1OTVkanJmcHR0cnh3OWF2cCIgdGltZXN0YW1wPSIxNTQzNjc5NTY1Ij4yMzcyPC9rZXk+

PC9mb3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10

eXBlPjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5LYWhyaWxhcywgUC4gSi48L2F1dGhv

cj48YXV0aG9yPkthdHprYSwgRC48L2F1dGhvcj48YXV0aG9yPlJpY2h0ZXIsIEouIEUuPC9hdXRo

b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+RGVwYXJ0bWVudCBvZiBN

ZWRpY2luZSwgTm9ydGh3ZXN0ZXJuIFVuaXZlcnNpdHkgRmVpbmJlcmcgU2Nob29sIG9mIE1lZGlj

aW5lLCBDaGljYWdvLCBJbGxpbm9pcy4gRWxlY3Ryb25pYyBhZGRyZXNzOiBwLWthaHJpbGFzQG5v

cnRod2VzdGVybi5lZHUuJiN4RDtEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBOb3J0aHdlc3Rlcm4g

VW5pdmVyc2l0eSBGZWluYmVyZyBTY2hvb2wgb2YgTWVkaWNpbmUsIENoaWNhZ28sIElsbGlub2lz

LjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNsaW5pY2FsIFByYWN0aWNlIFVwZGF0ZTog

VGhlIFVzZSBvZiBQZXItT3JhbCBFbmRvc2NvcGljIE15b3RvbXkgaW4gQWNoYWxhc2lhOiBFeHBl

cnQgUmV2aWV3IGFuZCBCZXN0IFByYWN0aWNlIEFkdmljZSBGcm9tIHRoZSBBR0EgSW5zdGl0dXRl

PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L3NlY29uZGFyeS10aXRs

ZT48YWx0LXRpdGxlPkdhc3Ryb2VudGVyb2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9k

aWNhbD48ZnVsbC10aXRsZT5HYXN0cm9lbnRlcm9sb2d5PC9mdWxsLXRpdGxlPjxhYmJyLTE+R2Fz

dHJvZW50ZXJvbG9neTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwt

dGl0bGU+R2FzdHJvZW50ZXJvbG9neTwvZnVsbC10aXRsZT48YWJici0xPkdhc3Ryb2VudGVyb2xv

Z3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjA1LTEyMTE8L3BhZ2VzPjx2b2x1

bWU+MTUzPC92b2x1bWU+PG51bWJlcj41PC9udW1iZXI+PGVkaXRpb24+MjAxNy8xMC8xMTwvZWRp

dGlvbj48a2V5d29yZHM+PGtleXdvcmQ+RXNvcGhhZ2VhbCBBY2hhbGFzaWEvZGlhZ25vc2lzL3Bo

eXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnaXRpcywgUGVw

dGljL2RydWcgdGhlcmFweS9ldGlvbG9neTwva2V5d29yZD48a2V5d29yZD5Fc29waGFnb3Njb3B5

L2FkdmVyc2UgZWZmZWN0cy9tZXRob2RzLypzdGFuZGFyZHM8L2tleXdvcmQ+PGtleXdvcmQ+RXNv

cGhhZ3VzL3BoeXNpb3BhdGhvbG9neS8qc3VyZ2VyeTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8

L2tleXdvcmQ+PGtleXdvcmQ+TGFwYXJvc2NvcHk8L2tleXdvcmQ+PGtleXdvcmQ+Kk1vdXRoPC9r

ZXl3b3JkPjxrZXl3b3JkPk5hdHVyYWwgT3JpZmljZSBFbmRvc2NvcGljIFN1cmdlcnkvYWR2ZXJz

ZSBlZmZlY3RzL21ldGhvZHMvKnN0YW5kYXJkczwva2V5d29yZD48a2V5d29yZD5QYXRpZW50IFNl

bGVjdGlvbjwva2V5d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9rZXl3

b3JkPjxrZXl3b3JkPlByb3RvbiBQdW1wIEluaGliaXRvcnMvdGhlcmFwZXV0aWMgdXNlPC9rZXl3

b3JkPjxrZXl3b3JkPlJpc2sgRmFjdG9yczwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0

Y29tZTwva2V5d29yZD48a2V5d29yZD4qQWNoYWxhc2lhPC9rZXl3b3JkPjxrZXl3b3JkPipFc29w

aGFnZWFsIE1vdGlsaXR5IERpc29yZGVyczwva2V5d29yZD48a2V5d29yZD4qSGlnaC1SZXNvbHV0

aW9uIE1hbm9tZXRyeTwva2V5d29yZD48a2V5d29yZD4qUGVyLU9yYWwgRW5kb3Njb3BpYyBNeW90

b215PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRl

cz48ZGF0ZT5Ob3Y8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDE2LTUwODU8L2lz

Ym4+PGFjY2Vzc2lvbi1udW0+Mjg5ODkwNTk8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxj

dXN0b20yPlBNQzU2NzAwMTM8L2N1c3RvbTI+PGN1c3RvbTY+TklITVM5MTMxMTk8L2N1c3RvbTY+

PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwNTMvai5nYXN0cm8uMjAxNy4xMC4wMDE8L2Vs

ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxyZW1vdGUtZGF0YWJhc2UtcHJvdmlkZXI+TkxNPC9yZW1v

dGUtZGF0YWJhc2UtcHJvdmlkZXI+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9D

aXRlPjwvRW5kTm90ZT5=

ADDIN EN.CITE.DATA [8]. Most of adverse events that are associated with POEM are mild and severe adverse events area rare. Serious adverse events are preformation, pneumothorax, and bleedingPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYWl0by1DaGF2ZXo8L0F1dGhvcj48WWVhcj4yMDE3PC9Z

ZWFyPjxSZWNOdW0+MjM3NDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJz

Y3JpcHQiPlsyN108L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzc0

PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5

dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDM2ODk3OTgiPjIzNzQ8

L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv

cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhhaXRvLUNoYXZleiwgWS48

L2F1dGhvcj48YXV0aG9yPklub3VlLCBILjwvYXV0aG9yPjxhdXRob3I+QmVhcmQsIEsuIFcuPC9h

dXRob3I+PGF1dGhvcj5EcmFnYW5vdiwgUC4gVi48L2F1dGhvcj48YXV0aG9yPlVqaWtpLCBNLjwv

YXV0aG9yPjxhdXRob3I+UmFoZGVuLCBCLiBILiBBLjwvYXV0aG9yPjxhdXRob3I+RGVzYWksIFAu

IE4uPC9hdXRob3I+PGF1dGhvcj5QaW9jaGUsIE0uPC9hdXRob3I+PGF1dGhvcj5IYXllZSwgQi48

L2F1dGhvcj48YXV0aG9yPkhhamksIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRo

b3I+PGF1dGhvcj5SZWF2aXMsIEsuPC9hdXRob3I+PGF1dGhvcj5PbmltYXJ1LCBNLjwvYXV0aG9y

PjxhdXRob3I+QmFsYXNzb25lLCBWLjwvYXV0aG9yPjxhdXRob3I+TmFrYW11cmEsIEouPC9hdXRo

b3I+PGF1dGhvcj5IYXRhLCBZLjwvYXV0aG9yPjxhdXRob3I+WWFuZywgRC48L2F1dGhvcj48YXV0

aG9yPlBhbm51LCBELjwvYXV0aG9yPjxhdXRob3I+QWJiYXMsIEEuPC9hdXRob3I+PGF1dGhvcj5Q

ZXJidGFuaSwgWS4gQi48L2F1dGhvcj48YXV0aG9yPlBhdGVsLCBMLiBZLjwvYXV0aG9yPjxhdXRo

b3I+Rmlsc2VyLCBKLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1dGhvcj5S

aXZvcnksIEouPC9hdXRob3I+PGF1dGhvcj5NaW9uLCBGLjwvYXV0aG9yPjxhdXRob3I+UG9uY2hv

biwgVC48L2F1dGhvcj48YXV0aG9yPlBlcnJldHRhLCBTLjwvYXV0aG9yPjxhdXRob3I+V29uZywg

Vi48L2F1dGhvcj48YXV0aG9yPk1hc2VsbGksIFIuPC9hdXRob3I+PGF1dGhvcj5OZ2FtcnVlbmdw

aG9uZywgUy48L2F1dGhvcj48YXV0aG9yPkNoZW4sIFkuIEkuPC9hdXRob3I+PGF1dGhvcj5CdWto

YXJpLCBNLjwvYXV0aG9yPjxhdXRob3I+SGFqaXlldmEsIEcuPC9hdXRob3I+PGF1dGhvcj5Jc21h

aWwsIEEuPC9hdXRob3I+PGF1dGhvcj5QaWVyYXR0aSwgUi48L2F1dGhvcj48YXV0aG9yPkt1bWJo

YXJpLCBWLjwvYXV0aG9yPjxhdXRob3I+R2FsZG9zLUNhcmRlbmFzLCBHLjwvYXV0aG9yPjxhdXRo

b3I+UmVwaWNpLCBBLjwvYXV0aG9yPjxhdXRob3I+S2hhc2hhYiwgTS4gQS48L2F1dGhvcj48L2F1

dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EaXZpc2lvbiBvZiBHYXN0cm9lbnRl

cm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBUaGUgSm9obnMgSG9wa2lucyBNZWRpY2FsIEluc3RpdHV0

aW9ucywgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVVNBLiYjeEQ7RGlnZXN0aXZlIERpc2Vhc2VzIENl

bnRlciwgU2hvd2EgVW5pdmVyc2l0eSBLb3RvLVRveW9zdSBIb3NwaXRhbCwgVG9reW8sIEphcGFu

LiYjeEQ7VGhlIE9yZWdvbiBDbGluaWMsIE9yZWdvbiwgT3JlZ29uLCBVU0EuJiN4RDtEaXZpc2lv

biBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBVbml2ZXJzaXR5IG9mIEZsb3Jp

ZGEgQ29sbGVnZSBvZiBNZWRpY2luZSwgR2FpbmVzdmlsbGUsIEZsb3JpZGEsIFVTQS4mI3hEO0Rl

cGFydG1lbnQgb2YgU3VyZ2VyeSwgTm9ydGhTaG9yZSBVbml2ZXJzaXR5IEhlYWx0aCBTeXN0ZW0s

IEV2YW5zdG9uLCBJbGxpbm9pcywgVVNBLiYjeEQ7RGVwYXJ0bWVudCBvZiBHZW5lcmFsLCBWaXNj

ZXJhbCwgVmFzY3VsYXIgYW5kIFBlZGlhdHJpYyBTdXJnZXJ5LCBVbml2ZXJzaXR5IE1lZGljYWwg

Q2VudGVyLCBXaXJ6YnVyZywgR2VybWFueS4mI3hEO1N1cmF0IEluc3RpdHV0ZSBvZiBEaWdlc3Rp

dmUgU2NpZW5jZXMsIFN1cmF0LCBJbmRpYS4mI3hEO1VuaXZlcnNpdGUgZGUgTHlvbiBhbmQgSG9z

cGljZXMgQ2l2aWxzIGRlIEx5b24sIERpZ2VzdGl2ZSBQaHlzaW9sb2d5LCBFIEhlcnJpb3QgSG9z

cGl0YWwsIEx5b24sIEZyYW5jZS4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwg

S2luZyZhcG9zO3MgQ29sbGVnZSBIb3NwaXRhbCBOSFMgRm91bmRhdGlvbiBUcnVzdCwgTG9uZG9u

LCBVSy4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwgUm95YWwgUHJpbmNlIEFs

ZnJlZCBIb3NwaXRhbCwgQ2FtcGVyZG93biwgTmV3IFNvdXRoIFdhbGVzLCBBdXN0cmFsaWEuJiN4

RDtEZXBhcnRtZW50IG9mIEdhc3Ryb2ludGVzdGluYWwgYW5kIEVuZG9jcmluZSBTdXJnZXJ5LCBV

bml2ZXJzaXR5IG9mIFN0cmFzYm91cmcsIFN0cmFzYm91cmcsIEZyYW5jZS4mI3hEO0dhc3Ryb2Vu

dGVyb2xvZ3ksIEh1bWFuaXRhcyBDbGluaWNhbCBhbmQgUmVzZWFyY2ggSG9zcGl0YWwsIElSQ0NT

LCBSb3p6YW5vLCBJdGFseS4mI3hEO1RoZSBJbnRlcm5hdGlvbmFsIEhlYWx0aCBEZXBhcnRtZW50

LUdsb2JhbCBEaXNlYXNlIEVwaWRlbWlvbG9neSBhbmQgQ29udHJvbC1UaGUgSm9obnMgSG9wa2lu

cyBTY2hvb2wgb2YgUHVibGljIEhlYWx0aCwgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVVNBLjwvYXV0

aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNvbXByZWhlbnNpdmUgQW5hbHlzaXMgb2YgQWR2ZXJz

ZSBFdmVudHMgQXNzb2NpYXRlZCBXaXRoIFBlciBPcmFsIEVuZG9zY29waWMgTXlvdG9teSBpbiAx

ODI2IFBhdGllbnRzOiBBbiBJbnRlcm5hdGlvbmFsIE11bHRpY2VudGVyIFN0dWR5PC90aXRsZT48

c2Vjb25kYXJ5LXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQt

dGl0bGU+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVs

bC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8

L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2Fz

dHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdh

c3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjY3LTEyNzY8

L3BhZ2VzPjx2b2x1bWU+MTEyPC92b2x1bWU+PG51bWJlcj44PC9udW1iZXI+PGVkaXRpb24+MjAx

Ny8wNS8yNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdv

cmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DYXNlLUNvbnRyb2wgU3R1ZGllczwva2V5d29yZD48

a2V5d29yZD5Db2hvcnQgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHkvKmFkdmVy

c2UgZWZmZWN0czwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIEFjaGFsYXNpYS8qc3VyZ2Vy

eTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3

b3JkPjxrZXl3b3JkPkluY2lkZW5jZTwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxr

ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBvc3RvcGVyYXRpdmUgQ29tcGxp

Y2F0aW9ucy8qZXBpZGVtaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlRyZWF0bWVudCBPdXRjb21l

PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48

ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lzYm4+

PGFjY2Vzc2lvbi1udW0+Mjg1MzQ1MjE8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxlbGVj

dHJvbmljLXJlc291cmNlLW51bT4xMC4xMDM4L2FqZy4yMDE3LjEzOTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1w

cm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3Rl

PgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYWl0by1DaGF2ZXo8L0F1dGhvcj48WWVhcj4yMDE3PC9Z

ZWFyPjxSZWNOdW0+MjM3NDwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJz

Y3JpcHQiPlsyN108L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4yMzc0

PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iNTB3eGRwemQ5

dmQ1cjdlOXQ1YjU5NWRqcmZwdHRyeHc5YXZwIiB0aW1lc3RhbXA9IjE1NDM2ODk3OTgiPjIzNzQ8

L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwv

cmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkhhaXRvLUNoYXZleiwgWS48

L2F1dGhvcj48YXV0aG9yPklub3VlLCBILjwvYXV0aG9yPjxhdXRob3I+QmVhcmQsIEsuIFcuPC9h

dXRob3I+PGF1dGhvcj5EcmFnYW5vdiwgUC4gVi48L2F1dGhvcj48YXV0aG9yPlVqaWtpLCBNLjwv

YXV0aG9yPjxhdXRob3I+UmFoZGVuLCBCLiBILiBBLjwvYXV0aG9yPjxhdXRob3I+RGVzYWksIFAu

IE4uPC9hdXRob3I+PGF1dGhvcj5QaW9jaGUsIE0uPC9hdXRob3I+PGF1dGhvcj5IYXllZSwgQi48

L2F1dGhvcj48YXV0aG9yPkhhamksIEEuPC9hdXRob3I+PGF1dGhvcj5TYXhlbmEsIFAuPC9hdXRo

b3I+PGF1dGhvcj5SZWF2aXMsIEsuPC9hdXRob3I+PGF1dGhvcj5PbmltYXJ1LCBNLjwvYXV0aG9y

PjxhdXRob3I+QmFsYXNzb25lLCBWLjwvYXV0aG9yPjxhdXRob3I+TmFrYW11cmEsIEouPC9hdXRo

b3I+PGF1dGhvcj5IYXRhLCBZLjwvYXV0aG9yPjxhdXRob3I+WWFuZywgRC48L2F1dGhvcj48YXV0

aG9yPlBhbm51LCBELjwvYXV0aG9yPjxhdXRob3I+QWJiYXMsIEEuPC9hdXRob3I+PGF1dGhvcj5Q

ZXJidGFuaSwgWS4gQi48L2F1dGhvcj48YXV0aG9yPlBhdGVsLCBMLiBZLjwvYXV0aG9yPjxhdXRo

b3I+Rmlsc2VyLCBKLjwvYXV0aG9yPjxhdXRob3I+Um9tYW4sIFMuPC9hdXRob3I+PGF1dGhvcj5S

aXZvcnksIEouPC9hdXRob3I+PGF1dGhvcj5NaW9uLCBGLjwvYXV0aG9yPjxhdXRob3I+UG9uY2hv

biwgVC48L2F1dGhvcj48YXV0aG9yPlBlcnJldHRhLCBTLjwvYXV0aG9yPjxhdXRob3I+V29uZywg

Vi48L2F1dGhvcj48YXV0aG9yPk1hc2VsbGksIFIuPC9hdXRob3I+PGF1dGhvcj5OZ2FtcnVlbmdw

aG9uZywgUy48L2F1dGhvcj48YXV0aG9yPkNoZW4sIFkuIEkuPC9hdXRob3I+PGF1dGhvcj5CdWto

YXJpLCBNLjwvYXV0aG9yPjxhdXRob3I+SGFqaXlldmEsIEcuPC9hdXRob3I+PGF1dGhvcj5Jc21h

aWwsIEEuPC9hdXRob3I+PGF1dGhvcj5QaWVyYXR0aSwgUi48L2F1dGhvcj48YXV0aG9yPkt1bWJo

YXJpLCBWLjwvYXV0aG9yPjxhdXRob3I+R2FsZG9zLUNhcmRlbmFzLCBHLjwvYXV0aG9yPjxhdXRo

b3I+UmVwaWNpLCBBLjwvYXV0aG9yPjxhdXRob3I+S2hhc2hhYiwgTS4gQS48L2F1dGhvcj48L2F1

dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EaXZpc2lvbiBvZiBHYXN0cm9lbnRl

cm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBUaGUgSm9obnMgSG9wa2lucyBNZWRpY2FsIEluc3RpdHV0

aW9ucywgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVVNBLiYjeEQ7RGlnZXN0aXZlIERpc2Vhc2VzIENl

bnRlciwgU2hvd2EgVW5pdmVyc2l0eSBLb3RvLVRveW9zdSBIb3NwaXRhbCwgVG9reW8sIEphcGFu

LiYjeEQ7VGhlIE9yZWdvbiBDbGluaWMsIE9yZWdvbiwgT3JlZ29uLCBVU0EuJiN4RDtEaXZpc2lv

biBvZiBHYXN0cm9lbnRlcm9sb2d5IGFuZCBIZXBhdG9sb2d5LCBVbml2ZXJzaXR5IG9mIEZsb3Jp

ZGEgQ29sbGVnZSBvZiBNZWRpY2luZSwgR2FpbmVzdmlsbGUsIEZsb3JpZGEsIFVTQS4mI3hEO0Rl

cGFydG1lbnQgb2YgU3VyZ2VyeSwgTm9ydGhTaG9yZSBVbml2ZXJzaXR5IEhlYWx0aCBTeXN0ZW0s

IEV2YW5zdG9uLCBJbGxpbm9pcywgVVNBLiYjeEQ7RGVwYXJ0bWVudCBvZiBHZW5lcmFsLCBWaXNj

ZXJhbCwgVmFzY3VsYXIgYW5kIFBlZGlhdHJpYyBTdXJnZXJ5LCBVbml2ZXJzaXR5IE1lZGljYWwg

Q2VudGVyLCBXaXJ6YnVyZywgR2VybWFueS4mI3hEO1N1cmF0IEluc3RpdHV0ZSBvZiBEaWdlc3Rp

dmUgU2NpZW5jZXMsIFN1cmF0LCBJbmRpYS4mI3hEO1VuaXZlcnNpdGUgZGUgTHlvbiBhbmQgSG9z

cGljZXMgQ2l2aWxzIGRlIEx5b24sIERpZ2VzdGl2ZSBQaHlzaW9sb2d5LCBFIEhlcnJpb3QgSG9z

cGl0YWwsIEx5b24sIEZyYW5jZS4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwg

S2luZyZhcG9zO3MgQ29sbGVnZSBIb3NwaXRhbCBOSFMgRm91bmRhdGlvbiBUcnVzdCwgTG9uZG9u

LCBVSy4mI3hEO0RlcGFydG1lbnQgb2YgR2FzdHJvZW50ZXJvbG9neSwgUm95YWwgUHJpbmNlIEFs

ZnJlZCBIb3NwaXRhbCwgQ2FtcGVyZG93biwgTmV3IFNvdXRoIFdhbGVzLCBBdXN0cmFsaWEuJiN4

RDtEZXBhcnRtZW50IG9mIEdhc3Ryb2ludGVzdGluYWwgYW5kIEVuZG9jcmluZSBTdXJnZXJ5LCBV

bml2ZXJzaXR5IG9mIFN0cmFzYm91cmcsIFN0cmFzYm91cmcsIEZyYW5jZS4mI3hEO0dhc3Ryb2Vu

dGVyb2xvZ3ksIEh1bWFuaXRhcyBDbGluaWNhbCBhbmQgUmVzZWFyY2ggSG9zcGl0YWwsIElSQ0NT

LCBSb3p6YW5vLCBJdGFseS4mI3hEO1RoZSBJbnRlcm5hdGlvbmFsIEhlYWx0aCBEZXBhcnRtZW50

LUdsb2JhbCBEaXNlYXNlIEVwaWRlbWlvbG9neSBhbmQgQ29udHJvbC1UaGUgSm9obnMgSG9wa2lu

cyBTY2hvb2wgb2YgUHVibGljIEhlYWx0aCwgQmFsdGltb3JlLCBNYXJ5bGFuZCwgVVNBLjwvYXV0

aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNvbXByZWhlbnNpdmUgQW5hbHlzaXMgb2YgQWR2ZXJz

ZSBFdmVudHMgQXNzb2NpYXRlZCBXaXRoIFBlciBPcmFsIEVuZG9zY29waWMgTXlvdG9teSBpbiAx

ODI2IFBhdGllbnRzOiBBbiBJbnRlcm5hdGlvbmFsIE11bHRpY2VudGVyIFN0dWR5PC90aXRsZT48

c2Vjb25kYXJ5LXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvc2Vjb25kYXJ5LXRpdGxlPjxhbHQt

dGl0bGU+VGhlIEFtZXJpY2FuIGpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neTwvYWx0LXRpdGxl

PjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2FzdHJvZW50ZXJvbDwvZnVs

bC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3k8

L2FiYnItMT48L3BlcmlvZGljYWw+PGFsdC1wZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkFtIEogR2Fz

dHJvZW50ZXJvbDwvZnVsbC10aXRsZT48YWJici0xPlRoZSBBbWVyaWNhbiBqb3VybmFsIG9mIGdh

c3Ryb2VudGVyb2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4xMjY3LTEyNzY8

L3BhZ2VzPjx2b2x1bWU+MTEyPC92b2x1bWU+PG51bWJlcj44PC9udW1iZXI+PGVkaXRpb24+MjAx

Ny8wNS8yNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtleXdv

cmQ+QWdlZDwva2V5d29yZD48a2V5d29yZD5DYXNlLUNvbnRyb2wgU3R1ZGllczwva2V5d29yZD48

a2V5d29yZD5Db2hvcnQgU3R1ZGllczwva2V5d29yZD48a2V5d29yZD5FbmRvc2NvcHkvKmFkdmVy

c2UgZWZmZWN0czwva2V5d29yZD48a2V5d29yZD5Fc29waGFnZWFsIEFjaGFsYXNpYS8qc3VyZ2Vy

eTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3

b3JkPjxrZXl3b3JkPkluY2lkZW5jZTwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxr

ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPlBvc3RvcGVyYXRpdmUgQ29tcGxp

Y2F0aW9ucy8qZXBpZGVtaW9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlRyZWF0bWVudCBPdXRjb21l

PC9rZXl3b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMTc8L3llYXI+PHB1Yi1kYXRlcz48

ZGF0ZT5BdWc8L2RhdGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDAyLTkyNzA8L2lzYm4+

PGFjY2Vzc2lvbi1udW0+Mjg1MzQ1MjE8L2FjY2Vzc2lvbi1udW0+PHVybHM+PC91cmxzPjxlbGVj

dHJvbmljLXJlc291cmNlLW51bT4xMC4xMDM4L2FqZy4yMDE3LjEzOTwvZWxlY3Ryb25pYy1yZXNv

dXJjZS1udW0+PHJlbW90ZS1kYXRhYmFzZS1wcm92aWRlcj5OTE08L3JlbW90ZS1kYXRhYmFzZS1w

cm92aWRlcj48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3Rl

PgB=

ADDIN EN.CITE.DATA [27].conclusionEGJOO is a distinct motility disorder that encompasses a heterogenous group of underlying etiologies. It is a manometric diagnosis and further adjunctive tests (e.g., endoscopy, TBE, and CT scan) can help further reveal the cause of the obstruction at the EGJ. The course of action depends on the underling etiology and the therapeutic strategy should be personalized to each individual patient’s case. In cases of functional EGJOO, therapies directed at the LES (e.g., pneumatic dilation, PEOM, and botulinum injections) are usually needed for patients with persistent symptoms. Perhaps the definition of EGJOO need to be revised based on the manometric predictors and taking into consideration the IRP value in the upright position, as these implicate the course of action that may need to be taken regarding treatment and timing of intervention.References1 Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE; International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27: 160-174 [PMID: 25469569 DOI: 10.1111/nmo.12477]2 Ghosh SK, Pandolfino JE, Rice J, Clarke JO, Kwiatek M, Kahrilas PJ. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 2007; 293: G878-G885 [PMID: 17690172 DOI: 10.1152/ajpgi.00252.2007]3 do Carmo GC, Jafari J, Sifrim D, de Oliveira RB. Normal esophageal pressure topography metrics for data derived from the Sandhill-Unisensor high-resolution manometry assembly in supine and sitting positions. Neurogastroenterol Motil 2015; 27: 285-292 [PMID: 25557525 DOI: 10.1111/nmo.12501]4 Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in Management of Esophageal Motility Disorders. Clin Gastroenterol Hepatol 2018; 16: 1692-1700 [PMID: 29702296 DOI: 10.1016/j.cgh.2018.04.026]5 Okeke FC, Raja S, Lynch KL, Dhalla S, Nandwani M, Stein EM, Chander Roland B, Khashab MA, Saxena P, Kumbhari V, Ahuja NK, Clarke JO. What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil 2017; 29: [PMID: 28393437 DOI: 10.1111/nmo.13061]6 Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil 2017; 29: 1-9 [PMID: 28544670 DOI: 10.1111/nmo.13105]7 Ratuapli SK, Crowell MD, DiBaise JK, Vela MF, Ramirez FC, Burdick GE, Lacy BE, Murray JA. Opioid-Induced Esophageal Dysfunction (OIED) in Patients on Chronic Opioids. Am J Gastroenterol 2015; 110: 979-984 [PMID: 26032150 DOI: 10.1038/ajg.2015.154]8 Kahrilas PJ, Katzka D, Richter JE. Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice?From the AGA Institute. Gastroenterology 2017; 153: 1205-1211 [PMID: 28989059 DOI: 10.1053/j.gastro.2017.10.001]9 Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg 2009; 13: 2219-2225 [PMID: 19672666 DOI: 10.1007/s11605-009-0975-7]10 Song BG, Min YW, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Clinicomanometric factors associated with clinically relevant esophagogastric junction outflow obstruction from the Sandhill high-resolution manometry system. Neurogastroenterol Motil 2018; 30: [PMID: 29024314 DOI: 10.1111/nmo.13221]11 Triggs J, Carlson D, Beveridge C, Jain A, Tye MY, Kahrilas PJ, Pandolfino JE. Upright integrated relaxation pressure facilitates characterization of esophagogastric junction outlet obstruction. DDW, 201812 Carlson DA, Gyawali CP. Is High-Resolution Manometry Always Needed for the Diagnosis of Achalasia? Clin Gastroenterol Hepatol 2018; 16: 480-482 [PMID: 28987504 DOI: 10.1016/j.cgh.2017.06.019]13 de Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, Obuchowski N, Koehler RE, Richter J, Baker ME. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol 1997; 169: 473-479 [PMID: 9242756 DOI: 10.2214/ajr.169.2.9242756]14 Blonski W, Kumar A, Feldman J, Richter JE. Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia. Am J Gastroenterol 2018; 113: 196-203 [PMID: 29257145 DOI: 10.1038/ajg.2017.370]15 Carlson DA, Kahrilas PJ, Lin Z, Hirano I, Gonsalves N, Listernick Z, Ritter K, Tye M, Ponds FA, Wong I, Pandolfino JE. Evaluation of Esophageal Motility Utilizing the Functional Lumen Imaging Probe. Am J Gastroenterol 2016; 111: 1726-1735 [PMID: 27725650 DOI: 10.1038/ajg.2016.454]16 Hirano I, Pandolfino JE, Boeckxstaens GE. Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol 2017; 15: 325-334 [PMID: 28212976 DOI: 10.1016/j.cgh.2016.10.022]17 Molina-Infante J, Lucendo AJ. Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: A Paradigm Shift. Am J Gastroenterol 2017; 112: 1770-1773 [PMID: 29087399 DOI: 10.1038/ajg.2017.404]18 Pérez-Fernández MT, Santander C, Marinero A, Burgos-Santamaría D, Chavarría-Herbozo C. Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil 2016; 28: 116-126 [PMID: 26517978 DOI: 10.1111/nmo.12708]19 Clayton SB, Patel R, Richter JE. Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes. Clin Gastroenterol Hepatol 2016; 14: 907-911 [PMID: 26792374 DOI: 10.1016/j.cgh.2015.12.041]20 Khashab MA, Familiari P, Draganov PV, Aridi HD, Cho JY, Ujiki M, Rio Tinto R, Louis H, Desai PN, Velanovich V, Albéniz E, Haji A, Marks J, Costamagna G, Devière J, Perbtani Y, Hedberg M, Estremera F, Martin Del Campo LA, Yang D, Bukhari M, Brewer O, Sanaei O, Fayad L, Agarwal A, Kumbhari V, Chen YI. Peroral endoscopic myotomy is effective and safe in non-achalasia esophageal motility disorders: an international multicenter study. Endosc Int Open 2018; 6: E1031-E1036 [PMID: 30105290 DOI: 10.1055/a-0625-6288]21 Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg 2006; 243: 579-84; discussion 584-6 [PMID: 16632991 DOI: 10.1097/01.sla.0000217524.75529.2d]22 Pandolfino JE, Kahrilas PJ. Presentation, diagnosis, and management of achalasia. Clin Gastroenterol Hepatol 2013; 11: 887-897 [PMID: 23395699 DOI: 10.1016/j.cgh.2013.01.032]23 Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol 2012; 107: 1817-1825 [PMID: 23032978 DOI: 10.1038/ajg.2012.332]24 Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR; European Achalasia Trial Investigators. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364: 1807-1816 [PMID: 21561346 DOI: 10.1056/NEJMoa1010502]25 Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271 [PMID: 20354937 DOI: 10.1055/s-0029-1244080]26 Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE. Per-Oral Endoscopic Myotomy: A Series of 500 Patients. J Am Coll Surg 2015; 221: 256-264 [PMID: 26206634 DOI: 10.1016/j.jamcollsurg.2015.03.057]27 Haito-Chavez Y, Inoue H, Beard KW, Draganov PV, Ujiki M, Rahden BHA, Desai PN, Pioche M, Hayee B, Haji A, Saxena P, Reavis K, Onimaru M, Balassone V, Nakamura J, Hata Y, Yang D, Pannu D, Abbas A, Perbtani YB, Patel LY, Filser J, Roman S, Rivory J, Mion F, Ponchon T, Perretta S, Wong V, Maselli R, Ngamruengphong S, Chen YI, Bukhari M, Hajiyeva G, Ismail A, Pieratti R, Kumbhari V, Galdos-Cardenas G, Repici A, Khashab MA. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol 2017; 112: 1267-1276 [PMID: 28534521 DOI: 10.1038/ajg.2017.139]P-Reviewer: Gupta V, Xiao JW S-Editor: Gong ZML-Editor: A E-Editor: Yin SYSpecialty type: Gastroenterology and hepatologyCountry of origin: United StatesPeer-review report classificationGrade A (Excellent): 0Grade B (Very good): 0Grade C (Good): C, CGrade D (Fair): 0Grade E (Poor): 0 Figure 1 high-resolution manometry image. Panel A represents a normal high-resolution manometry (HRM) image of the esophagus with normal integrated relaxation pressure of 6 mmHg. Panel B represents an HRM image of esophagogastric junction outflow obstruction with IRP of 20 mmHg and reserved peristalsis. The images are based on MMS technology system. Figure 2 A proposed algorithm for the management of esophagogastric junction outflow obstruction. HRM: High resolution manometry; TBE: Time barium swallow; LES: Lower esophageal sphincter; EGJOO: esophagogastric junction outflow obstruction; DCI: Distal contractile integral; IRP: Integrated relaxation pressure; PPI: proton pump inhibitor. Table 1 Etiologies of esophagogastric junction outflow obstructionConditionCommentsEarly or incompletely expressed achalasia The so called functional EGJOO, akin to achalasiaMechanical processExamples include EoE, esophagitis, hiatal hernia, strictures, rings, tumors at the EGJ, obstructing esophageal varices.Esophageal wall stiffnessInfiltrative esophageal processes, fibrosis, or malignancyExtrinsic vascular compressione.g., aneurysmal dilatation of the aortaCentral obesityDue to increased intra-abdominal pressureOpiate effectEGJOO is more prevalent in chronic opiate usersAnatomical changesExamples: Operations that affect EGJ (e.g., fundoplication, bariatric surgery), paraesophageal herniaFalse-positive finding (normal variant)Measurement errorEGJ: esophagogastric junction; EGJOO: esophagogastric junction outflow obstruction; EoE: eosinophilic esophagitis. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download