Table A1.
Specific physiological scenarios corresponding to each of the simulation cases
| Case Number | Myotomy Dimensions | Physiological Scenario |
|---|---|---|
| Simulation set 1: Pan-esophageal contraction, fully occluded EGJ | ||
| 1 | Length: 60 mm, width: 7 mm | Type II achalasia with incomplete myotomy or tight fundoplication |
| 2 | Length: 90 mm, width: 7 mm | |
| 3 | Length: 30 mm, width: 7 mm | |
| 4 | Length: 60 mm, width: 4 mm | |
| 5 | Length: 60 mm, width: 10 mm | |
| Case Number | Details | Physiological Scenario |
| Simulation set 2 | ||
| 1 | Peristalsis (normal), standard myotomy | EGJOO |
| 2 | Very weak contraction (achalasia I), standard myotomy | Type I achalasia |
| 3 | Pan-esophageal contraction (achalasia II), standard myotomy | Type II achalasia |
| 4 | Proximal peristalsis transitions with distal spasm (achalasia III), standard myotomy | Type III achalasia |
| 5 | Peristalsis (normal), short myotomy | EGJOO |
| 6 | Very weak contraction (achalasia I), short myotomy | Type I achalasia |
| 7 | Pan-esophageal contraction (achalasia II), short myotomy | Type II achalasia |
| 8 | Proximal peristalsis transitions with distal spasm (achalasia III), short myotomy | Type III achalasia |
| Case Number | Details | Physiological Scenario |
| Simulation set 3: group I | ||
| 1 | Standard myotomy length (6 cm); no EGJ tone; myotomy affected zone walled by mucosa only; contraction type: normal peristalsis | Long LHM with no fundoplication in patient with EGJOO |
| 2 | Standard myotomy length (6 cm); with an EGJ tone; myotomy affected zone walled by mucosa only; contraction type: normal peristalsis | Long LHM with tight fundoplication in patient with EGJOO |
| 3 | Standard myotomy length (6 cm); with an EGJ tone; myotomy affected zone walled by mucosa and weakened muscle layers (the strength of the muscle fibers were reduced by 99% but the matrix of the muscle layers were intact at the myotomy site); contraction type: normal peristalsis | Partially healed esophagus after long LHM with tight fundoplication in patient with EGJOO |
| 4 | Short myotomy length (3 cm); no EGJ tone; myotomy affected zone walled by mucosa only; contraction type: normal peristalsis | Short LHM with no fundoplication in patient with EGJOO |
| 5 | Short myotomy length (3 cm); with an EGJ tone; myotomy affected zone walled by mucosa only; contraction type: normal peristalsis | Short LHM with tight fundoplication in patient with EGJOO |
| 6 | Short myotomy length (3 cm); with an EGJ tone; myotomy affected zone walled by mucosa and weakened muscle layers (the strength of the muscle fibers were reduced by 99% but the matrix of the muscle layers were intact at the myotomy site); contraction type: normal peristalsis | Partially healed esophagus after short LHM with tight fundoplication in patient with EGJOO |
| Details | Physiological Scenario | |
| Simulation set 3: group II | ||
| POEM length: 12 cm; LM intact at the myotomy site while CM fibers were broken, and CM matrix strength reduced 100-fold; with an EGJ tone; contraction type: normal peristalsis | Esophagus after POEM | |
CM, circular muscle; EGJ, esophagogastric junction; EGJOO, esophagogastric junction outflow obstruction; LHM, laparoscopic Heller myotomy; LM, longitudinal muscle; POEM, Peroral endoscopic myotomy.