Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5863
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
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.
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.
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.
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.
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.
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.
A large-scale prospective study should be conducted to gain more evidence for the relationship between achalasia subtypes, LEMP thickness, and POEM prognosis.