摘要
BACKGROUND People with achalasia typically have a thick lower esophageal muscularis propria(LEMP),and peroral endoscopic myotomy(POEM)has been effective in treating most patients.LEMP thickness may be associated with the outcomes and prognosis after POEM.However,more evidence is needed regarding the relationship between LEMP thickness and patient prognosis after POEM.AIM To assess the association between LEMP thickness,measured using endoscopic ultrasound(EUS),and long-term prognosis,especially relapse,after POEM for achalasia.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.LEMP thickness was measured by EUS,and a thickness of≥3 mm was defined as thickened.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.RESULTS Eighty-two patients(32 males and 50 females,aged 17-78 years)and 85 POEM procedures were included.In total,76.8%(63/82 patients)of patients had a thickened muscularis propria.Older age and longer disease course were associated with muscularis propria thickening(P<0.05).The mean postoperative follow-up time was 35.4±17.2 mo(range,8-87.5 mo)in 60 patients.Five patients with Eckardt scores>3 refused further management after their symptoms were relieved.The relapse rate was 12.73%(7/55 cases).Five patients,four of whom had muscularis propria thickening,had disease recurrence within 12 mo after the procedure.Achalasia relapsed in one patient who had a thickened muscularis propria after 24 mo and in another patient who did not have a thickened muscularis propria after 30 mo.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
基金
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.
