Motility Assessment During Endoscopy: The CARS Score.

An upper endoscopy is often performed as one of the first tests in patients with dysphagia and other esophageal symptoms. Classically, patients with achalasia may present with a dilated, fluid and food filled esophagus with a tight "rosette"-appearing lower esophageal sphincter. However, patients may present with early stages of disease with more subtle findings that are not readily identified or documented. We present the components of a high-quality endoscopic examination for a motility assessment including identification and documentation of landmarks, assessment of the hiatus, and assessment of motility, presented as the "CARS score" based on Contents, Anatomy, Reseistance at the lower esophageal sphincter, and signs of Stasis findings.