Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cha Bundang Medical Center, 59 Yatapro, Bundang-gu, Seongnam-si, Korea.
Surg Endosc. 2024 Oct;38(10):5567-5574. doi: 10.1007/s00464-024-11108-y. Epub 2024 Aug 1.
Peroral endoscopic myotomy (POEM) is a standard procedure for achalasia, an esophageal motility disorder, characterized by a thickened lower esophageal sphincter muscularis propria (LEMP). Visualization of this anatomical stratification has been made possible by the advent of endoscopic ultrasound (EUS). However, the effect of LEMP thickness on treatment outcomes remains unclear. The objective of this study was to investigate whether LEMP thickness affects treatment response post-POEM.
This was a single-center, prospective cohort study of patients who underwent POEM between 2014 and 2021. Patients who underwent EUS to evaluate the LEMP before POEM were included in the study. We divided the patients into two groups according to muscle thickness measured by EUS (≥ 2.80 mm; group 1, < 2.80 mm; group 2). The pre- and post-procedural clinical parameters were compared between the two groups.
Among 278 patients, 189 were enrolled. There were no significant differences in the pre- and post-Eckardt scores, integrated relaxation pressure, and distensibility index between the two groups divided by muscle thickness. Furthermore, there was no statistically significant difference in symptom recurrence, as measured by an Eckardt score > 3, post-procedural complications, or post-POEM GERD symptoms. However, patients with thicker lower esophageal sphincter muscle showed a greater decrease in Eckardt scores (ΔES ≥ 3) which was statistically significant (P = 0.002).
POEM is an effective and safe treatment method for achalasia, regardless of LES muscle thickness. There was a statistically significant difference in the decrease of Eckardt scores of 3 or greater (ΔES ≥ 3) after POEM in the thicker LEMP group suggesting greater alleviation of symptoms in POEM patients with thicker lower esophageal muscle.
经口内镜下肌切开术（POEM）是治疗食管动力障碍疾病贲门失弛缓症的标准方法，其特征为食管下括约肌固有肌层（LEMP）增厚。内镜超声（EUS）的出现使得这种解剖分层的可视化成为可能。然而，LEMP 厚度对治疗结果的影响仍不清楚。本研究旨在探讨 LEMP 厚度是否影响 POEM 后的治疗反应。
这是一项 2014 年至 2021 年期间进行 POEM 的单中心前瞻性队列研究。将接受 EUS 评估 POEM 前 LEMP 的患者纳入研究。我们根据 EUS 测量的肌肉厚度将患者分为两组（≥2.80mm；组 1，<2.80mm；组 2）。比较两组之间的术前和术后临床参数。
在 278 名患者中，有 189 名患者入组。两组之间，Eckardt 评分、综合松弛压和可扩张性指数在术前和术后均无显著差异。此外，两组之间症状复发（Eckardt 评分>3）、术后并发症或 POEM 后 GERD 症状无统计学差异。然而，LEMP 较厚的患者 Eckardt 评分（ΔES≥3）下降更明显，具有统计学意义（P=0.002）。
POEM 是治疗贲门失弛缓症的一种有效且安全的方法，与 LES 肌肉厚度无关。POEM 后 Eckardt 评分降低 3 分或以上（ΔES≥3）在 LEMP 较厚的患者中存在统计学差异，提示 POEM 患者的食管下肌较厚时症状缓解更为明显。
