Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2025; 31(12): 99846
Published online Mar 28, 2025. doi: 10.3748/wjg.v31.i12.99846
Peroral endoscopic myotomy for achalasia and patients with normal lower-esophageal-sphincter integrated relaxation pressure: A propensity-score-matched retrospective study
Xiao Li, Xiao-Bin Zhang, Jia-Kang Shao, Bo Zhang, Long-Song Li, Rui-Qing Zhu, Jia-Le Zou, Jia-Feng Wang, Xin Zhao, Qing-Zhen Wu, Ning-Li Chai, En-Qiang Linghu
Xiao Li, Department of General Medicine, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
Xiao Li, Xiao-Bin Zhang, Bo Zhang, Long-Song Li, Rui-Qing Zhu, Jia-Le Zou, Jia-Feng Wang, Xin Zhao, Qing-Zhen Wu, Ning-Li Chai, En-Qiang Linghu, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Jia-Kang Shao, Medical School of Chinese PLA, Beijing 100853, China
Co-first authors: Xiao Li and Xiao-Bin Zhang.
Co-corresponding authors: Ning-Li Chai and En-Qiang Linghu.
Author contributions: Li X, Zhang XB, Chai NL and Linghu EQ conceived and designed the study; Zhang B, Li LS, Zhu RQ, Zou JL, Wang JF, Zhao X and Wu QZ contributed to the acquisition of data; Li X, Shao JK and Zhang XB did data analysis and interpretation; All the authors have read and approved the final manuscript. Li X and Zhang XB were co-first authors. Chai NL and Linghu EQ critically revised the article. Chai NL and Linghu EQ contributed equally to this paper and were co-corresponding authors.
Institutional review board statement: This study was approved by the ethics committee of Chinese PLA General Hospital (Approval No. S2021-206-01).
Informed consent statement: Informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request at linghuenqiang@vip.sina.com.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Qiang Linghu, MD, PhD, Chief Doctor, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: August 1, 2024
Revised: February 1, 2025
Accepted: March 3, 2025
Published online: March 28, 2025
Processing time: 237 Days and 2.9 Hours
Abstract
BACKGROUND

Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter (LES) pressure. Peroral endoscopic myotomy (POEM) has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.

AIM

To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure (LES-IRP).

METHODS

The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed. A total of 481 patients who underwent preoperative high-resolution manometry (HRM) at our hospital were ultimately included in this research. According to the HRM results, the patients were divided into two groups: 71 patients were included in the normal LES-IRP group (LES-IRP < 15 mmHg) and 410 patients were included in the increased LES-IRP group (LES-IRP ≥ 15 mmHg). Clinical characteristics, procedure-related parameters, adverse events, and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.

RESULTS

Among the 481 patients included in our study, 209 were males and 272 were females, with a mean age of 44.2 years. All patients underwent POEM without severe adverse events. The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0 (P = 0.132), respectively, decreasing to 1.0 and 1.0 post-treatment (P = 0.572). The clinical success rate of the normal LES-IRP group was 87.3% (62/71), and that of the increased LES-IRP group was 91.2% (374/410) (P = 0.298). Reflux symptoms were measured by the GerdQ questionnaire, and the percentages of patients with GerdQ scores ≥ 9 in the normal LES-IRP and increased LES-IRP groups were 8.5% and 10.7%, respectively (P = 0.711). After matching, the rates of clinical success and the rates of GerdQ score ≥ 9 were not significantly different between the two groups.

CONCLUSION

Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP. In addition, in patients with normal LES-IRP, compared with those with increased LES-IRP, POEM was not associated with a greater incidence of reflux symptoms.

Keywords: Peroral endoscopic myotomy; Achalasia; Lower esophageal sphincter integrated relaxation pressure; Safety; Efficacy

Core Tip: Peroral endoscopic myotomy (POEM) has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased lower esophageal sphincter (LES) pressure. However, there are few studies on safety and efficacy of POEM for patients with normal LES integrated relaxation pressure (LES-IRP). Therefore, we conducted a retrospective and found that POEM is safe and effective for achalasia and patients with normal LES-IRP. And POEM was not associated with a greater incidence of reflux symptoms in patients with normal LES-IRP.