Consensus on the digestive endoscopic tunnel technique

Table 1 Evidence-level classification

Level	Content
I	Based on a systematic review/meta-analysis of randomized controlled trials (RCTs)
II	Based on at least one RCT
III	Based on a non-RCT
IVa	Based on an analytical epidemiological study (cohort study)
IVb	Based on an analytical epidemiological study (case-control study, cross-sectional study)
V	Based on case series and case reports
VI	Based on opinions from a specialist committee or individual specialists without patient data

Table 2 Recommendation level

Strength of recommendation	Content
A	With strong scientific evidence, strongly recommended
B	With scientific evidence, recommended
C1	Without scientific evidence, but recommended
C2	Without scientific evidence, not recommended
D	With scientific evidence of ineffective or harmful results, not recommended

Table 3 Endoscopic morphological classification of achalasia cardia

Classification	Endoscopic observations
Ling I	Cavity of the oesophagus dilates, wall of the oesophagus is straight (without tortuosity) and smooth
Ling II	Cavity of the oesophagus dilates tortuously, with a circular or semi-circular structure occurring in the oesophagus after adequate gas injection
Ling IIa	Oesophageal cavity dilates, with a thin circular structure (no semi-circular structure) occurring in the oesophagus after adequate gas injection
Ling IIb	Oesophageal cavity dilates, with a semi-circular structure occurring (midpoint within 1/3 of the cavity)
Ling IIc	Oesophageal cavity dilates, with a semi-circular structure occurring (midpoint beyond 1/3 of the cavity)
Ling III	Oesophageal cavity dilates, with a diverticular structure
Ling IIIl	Diverticular structure mainly in the left wall of the oesophagus
Ling IIIr	Diverticular structure mainly in the right wall of the oesophagus
Ling IIIlr	Diverticular structure in both the left and right walls of the oesophagus

Table 4 Degree of inflammation of the oesophageal mucosa in achalasia cardia

Grade	Endoscopic observations
Grade A	Normal mucosa, with a clear vascular texture
Grade B	Rough mucosa with a vague vascular texture
Grade C	White granular mucosa without an obvious vascular texture
Grade D	Pachyntic, striated, or sulcus-shaped mucosa without an obvious vascular texture
Grade E	Ulcer in the mucosa
Grade E1	Involvement of the oesophageal lumen ≤ 1/4
Grade E2	1/4 < involvement of the oesophageal lumen ≤ 1/2
Grade E3	1/2 < involvement of the oesophageal lumen ≤ 3/4
Grade E4	Involvement of the oesophageal lumen > 3/4
Grade F	Scar in the mucosa
Grade F1	Involvement of the oesophageal lumen ≤ 1/4
Grade F2	1/4 < involvement of the oesophageal lumen ≤ 1/2
Grade F3	1/2 < involvement of the oesophageal lumen ≤ 3/4
Grade F4	Involvement of the oesophageal lumen > 3/4