Watanabe D, Tanaka S, Ariyoshi R, Abe H, Kawara F, Toyonaga T
Department of Endoscopy, Kobe University Hospital, Chuo-ku, Kobe, Japan.
Dis Esophagus. 2018 Jul 1;31(7). doi: 10.1093/dote/doy009.
Esophageal motility disorders can cause severe dysphagia, regurgitation, and/or noncardiac chest pain due to a lack of coordinated esophageal motility function. However, the clinical significance of esophageal muscle layer thickness remains unclear. The aims of this study are to elucidate the clinical significance of esophageal muscle layer thickness in patients with esophageal motility disorders who undergo peroral endoscopic myotomy (POEM), and to identify predictors of a longer POEM procedure time. Seventy-four consecutive patients with esophageal motility disorders who underwent POEM procedures at Kobe University Hospital from April 2015 to December 2016 were prospectively recruited into this study. First, we investigated the associations between the thickness of the esophageal muscular layer and clinical parameters. There were no significant differences, except in the POEM procedure time, between the patients with esophageal muscle layer thickness values of ≥1.5 mm (group A) and <1.5 mm (group B). However, the relative frequency of a longer POEM procedure time (≥78 min) was significantly higher in group A than in group B (66.7% vs. 19.5, P < 0.0001). Next, independent clinical factors that were related to longer POEM procedures were investigated. Multivariate logistic regression analysis with stepwise selection demonstrated that a thick esophageal muscle layer and the length of myotomy were an independent predictor of a longer POEM procedure (odds ratio: 13.9 and 12.0, respectively). Our results indicate that preoperative endoscopic ultrasonography evaluations can help to predict the technical complexity of POEM procedures.
食管动力障碍可因食管动力功能缺乏协调性而导致严重吞咽困难、反流和/或非心源性胸痛。然而，食管肌层厚度的临床意义仍不明确。本研究的目的是阐明接受经口内镜下肌切开术（POEM）的食管动力障碍患者食管肌层厚度的临床意义，并确定POEM手术时间较长的预测因素。2015年4月至2016年12月在神户大学医院接受POEM手术的74例连续食管动力障碍患者被前瞻性纳入本研究。首先，我们研究了食管肌层厚度与临床参数之间的关联。食管肌层厚度≥1.5 mm的患者（A组）和<1.5 mm的患者（B组）之间，除了POEM手术时间外，没有显著差异。然而，A组POEM手术时间较长（≥78分钟）的相对频率显著高于B组（66.7%对19.5%，P<0.0001）。接下来，研究了与POEM手术时间较长相关的独立临床因素。采用逐步选择的多因素逻辑回归分析表明，食管肌层增厚和肌切开长度是POEM手术时间较长的独立预测因素（优势比分别为13.9和12.0）。我们的结果表明，术前内镜超声评估有助于预测POEM手术的技术复杂性。
