Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2020; 26(38): 5863-5873
Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5863
Endoscopic ultrasound-measured muscular thickness of the lower esophageal sphincter and long-term prognosis after peroral endoscopic myotomy for achalasia
Ye Liao, Ting-Yue Xiao, Yu-Fan Wu, Jing-Jing Zhang, Bao-Zhen Zhang, Yi-Dan Wang, Sheng Wang, Xiang Liu, Si-Yu Sun, Jin-Tao Guo
Ye Liao, Yu-Fan Wu, Jing-Jing Zhang, Bao-Zhen Zhang, Yi-Dan Wang, Sheng Wang, Xiang Liu, Si-Yu Sun, Jin-Tao Guo, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Ting-Yue Xiao, Department of Science and Education, Shenyang Sixth People’s Hospital, Shenyang 110006, Liaoning Province, China
Author contributions: Liao Y and Guo JT were involved in the study conception and design; Guo JT, Wang S, Liu X, and Sun SY performed the research; Liao Y, Xiao TY, Wu YF, Zhang JJ, Zhang BZ, and Wang YD analyzed the data; Liao Y wrote the manuscript; Guo JT and Sun SY performed critical revision of the article for important intellectual content; all authors performed the final approval of the article.
Supported by National Natural Science Foundation of China, No. 81900601, Natural Science Foundation of Liaoning Province, No. 207541024; and Outstanding Scientific Fund of Shengjing Hospital, No. 201702.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board and the Ethics Committee of China Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Tao Guo, MD, PhD, Doctor, Professor, Research Fellow, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. guojt@sj-hospital.org
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: July 29, 2020
Revised: August 13, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 14, 2020
ARTICLE HIGHLIGHTS
Research background

Peroral endoscopic myotomy (POEM) procedure is an effective treatment for achalasia as it cuts open the lower esophageal muscularis propria (LEMP) directly. LEMP thickness of achalasia patients may be associated with the outcomes and prognosis after POEM.

Research motivation

Patients who undergo POEM are at risk for disease recurrence. Several predictors have been reported while the relationship between LEMP thickness and long-term prognosis after POEM is unclear.

Research objectives

In this retrospective study, we analyzed the relationship between LEMP thickness, patient characteristics, and long-term prognosis after POEM in individuals who underwent POEM for achalasia at our health center in the past seven years.

Research methods

All medical records, including EUS data, of patients who underwent POEM to treat achalasia at Shengjing Hospital of China Medical University from January 2012 to September 2018 were retrospectively reviewed. The severity of patient symptoms was evaluated using the Eckardt score. Relapse was defined as a 3-point rise in the Eckardt score after a period of clinical remission. The relationship between patient characteristics, muscle thickness, and recurrence was analyzed.

Research results

Older age and longer disease course were associated with muscularis propria thickening (P < 0.05). Patients with recurrence were typically younger and had a shorter disease course (P < 0.05). The relapse rate in patients with a non-thickened muscularis propria tended to be higher (18.2%, 2/11 patients) than patients with a thickened muscularis propria (11.4%, 5/44 patients), although no significant difference was found. Age (hazard ratio = 0.92; 95% confidence interval: 0.865-0.979; P < 0.05) and male sex (hazard ratio = 7.173; 95% confidence interval: 1.277-40.286; P < 0.05) were identified as risk factors for symptomatic recurrence by multivariable analysis using the Cox model.

Research conclusions

Patients with a thickened muscularis are typically older and have a longer disease course than those without a thickened muscularis. Younger age and male sex are associated with increased recurrence. Patients with a thin muscularis propria may be prone to relapse, although further validation is needed.

Research perspectives

A large-scale prospective study should be conducted to gain more evidence for the relationship between achalasia subtypes, LEMP thickness, and POEM prognosis.