Case Control Study
Copyright ©The Author(s) 2025.
World J Gastroenterol. Mar 28, 2025; 31(12): 99846
Published online Mar 28, 2025. doi: 10.3748/wjg.v31.i12.99846
Table 1 Clinical characteristics of the two groups, n (%)
Normal LES-IRP group (n = 71)
Increased LES-IRP group (n = 410)
P value
Sex, male/female (n)37/34172/2380.111
Age, median (Q1-Q3) (years)45.0 (35.0-57.0)43.0 (33.0-54.0)0.134
BMI, median (Q1-Q3) (kg/m2)21.5 (19.1-23.8)20.9 (19.2-23.7)0.543
Duration of symptoms,
median (Q1-Q3) (months)		72.0 (24.0-180.0)36.0 (24.0-84.0)0.006
Previous treatment21 (29.5)59 (14.4)0.002
    Balloon dilation10 (14.1)30 (7.3)
    Botox injection2 (2.8)16 (3.9)
    Temporary stenting1 (1.4)6 (1.5)
    Heller myotomy4 (5.6)2 (0.5)
    POEM1 (1.4)2 (0.5)
    Balloon dilation + botox injection1 (1.4)2 (0.5)
    Balloon dilation + temporary stenting2 (2.8)1 (0.2)
Pre-treatment HRM
    LES basal pressure, median (Q1-Q3) (mmHg)14.8 (12.0-20.3)32.3 (23.7-41.8)0.000
    LES-IRP, median (Q1-Q3) (mmHg)11.4 (9.2-12.5)25.7 (20.3-32.3)0.000
Ling classification0.014
    Type Ling I7 (9.9)84 (20.5)
    Type Ling IIa21 (29.6)142 (34.6)
    Type Ling IIb17 (23.9)105 (25.6)
    Type Ling IIc22 (31.0)66 (16.1)
    Type Ling III4 (5.6)13 (3.2)
Data were expressed as median (Q1-Q3) or n (%). Continuous variables were compared by Mann-Whitney U test. Categorical variables were compared by χ2 test or Fisher exact test. Q1: First quartile; Q3: Third quartile; BMI: Body mass index; HRM: High-resolution manometry; LES: Lower esophageal sphincter; LES-IRP: Lower esophageal sphincter integrated relaxation pressure; POEM: Peroral endoscopic myotomy; HRM: High-resolution manometry.
Table 2 Comparisons of procedure-related parameters, n (%)
Normal LES-IRP group (n = 71)
Increased LES-IRP group (n = 410)
P value
ASA classification0.328
    I6 (8.5)62 (15.1)
    II64 (90.1)342 (83.4)
    III1 (1.4)6 (1.5)
Operation time, median (Q1-Q3) (minute)40.0 (33.0-51.0)42.0 (32.0-55.0)0.519
Tunnel length, median (Q1-Q3) (cm)12.0 (9.0-12.0)12.0 (10.0-12.0)0.738
Myotomy length, median (Q1-Q3) (cm)7.0 (5.0-9.0)7.0 (6.0-9.0)0.661
Types of myotomy0.425
    Inner circular muscle myotomy7 (9.9)70 (17.1)
    Full-thickness muscle myotomy3 (4.2)30 (7.3)
    Partial-thickness muscle myotomy4 (5.6)19 (4.6)
    Glass-style anti-reflux myotomy1 (1.4)9 (2.2)
    Progressive full-thickness myotomy56 (78.9)282 (68.8)
Intraoperative adverse events5 (7.0)58 (14.2)0.186
    Bleeding1 (1.4)2 (0.5)
    Mucosal injury3 (4.2)29 (7.1)
    Gas-related adverse events1 (1.4)27 (6.6)
        Pneumothorax0 (0.0)1 (0.2)
        Pneumoperitoneum1 (1.4)13 (3.2)
        Pneumomediastinum0 (0.0)2 (0.5)
        Subcutaneous emphysema0 (0.0)11 (2.7)
Data were expressed as median (Q1-Q3) or n (%). Continuous variables were compared by Mann-Whitney U test. Categorical variables were compared by χ2 test or Fisher exact test. ASA classification: American Society of Anesthesiologists classification; Q1: First quartile; Q3: Third quartile; LES-IRP: Lower esophageal sphincter integrated relaxation pressure.
Table 3 Comparisons of Eckardt score and GerdQ score between the two groups, n (%)
Normal LES-IRP group (n = 71)
Increased LES-IRP group (n = 410)
P value
Follow-up period, median (Q1-Q3) (months)25.0 (19.0-57.0)41.0 (23.0-63.0)0.010
Clinical success (Eckardt score ≤ 3)62 (87.3)374 (91.2)0.298
Eckardt score, median (Q1-Q3)
    Pre-treatment7.0 (5.0-8.0)7.0 (6.0-9.0)0.132
    Post-treatment1.0 (0.0-2.0)1.0 (0.0-2.0)0.572
    Pre-post change5.0 (4.0-7.0)6.0 (4.0-8.0)0.068
GerdQ score, median (Q1-Q3)6.0 (6.0-7.0)6.0 (6.0-7.0)0.200
GerdQ score ≥ 96 (8.5)44 (10.7)0.561
Data were expressed as median (Q1-Q3) or n (%). Continuous variables were compared by Mann-Whitney U test. Categorical variables were compared by χ2 test or Fisher exact test. Q1: First quartile; Q3: Third quartile; LES-IRP: Lower esophageal sphincter integrated relaxation pressure.
Table 4 Clinical characteristics and outcomes matched by propensity score, n (%)
Normal LES-IRP group (n = 69)
Increased LES-IRP group (n = 69)
P value
Sex, male/female (n)35/3441/280.305
Age, median (Q1-Q3) (years)45.0 (34.0-55.0)44.0 (35.5-56.0)0.797
BMI, median (Q1-Q3) (kg/m2)21.5 (19.1-23.7)20.9 (19.0-24.1)0.764
Duration of symptoms, median (Q1-Q3) (months)60.0 (24.0-174.0)60.0 (24.0-120.0)0.582
Previous treatment19 (27.5)18 (26.1)0.848
ASA classification0.573
    I68
    II6259
    III12
Ling classification0.145
    Type Ling I6 (8.7)16 (23.2)
    Type Ling IIa21 (30.4)18 (26.1)
    Type Ling IIb17 (24.7)16 (23.2)
    Type Ling IIc21 (30.4)18 (26.1)
    Type Ling III4 (5.8)1 (1.4)
Pre-treatment HRM
    LES basal pressure, median (Q1-Q3) (mmHg)14.8 (12.0-20.3)31.9 (22.5-40.4)0.000
    LES-IRP, median (Q1-Q3) (mmHg)11.4 (9.3-12.5)22.3 (19.0-28.4)0.000
Follow-up period, median (Q1-Q3) (month)25.0 (18.5-54.5)42.0 (28.5-63.5)0.002
Clinical success (Eckardt score ≤ 3)61 (88.4)62 (89.9)0.784
Intraoperative adverse events5 (7.1)8 (11.5)1.000
    Bleeding1 (1.4)1 (1.4)
    Mucosal injury3 (4.3)4 (5.8)
    Gas-related adverse events1 (1.4)3 (4.3)
        Pneumothorax0 (0.0)1 (1.4)
        Pneumoperitoneum1 (1.4)2 (2.9)
Eckardt score, median (Q1-Q3)
    Pre-treatment7.0 (5.0-8.0)7.0 (6.0-9.0)0.021
    Post-treatment1.0 (0.0-2.0)1.0 (1.0-2.0)0.201
    Pre-post change5.0 (4.0-7.0)6.0 (4.0-8.0)0.086
GerdQ score, median (Q1-Q3)6.0 (6.0-7.0)6.0 (6.0-7.0)0.917
GerdQ score ≥ 96 (8.7)7 (10.1)0.771
Data were expressed as median (Q1-Q3) or n (%). Continuous variables were compared by Mann-Whitney U test. Categorical variables were compared by χ2 test or Fisher exact test. Q1: First quartile; Q3: Third quartile; BMI: Body mass index; LES: Lower esophageal sphincter; LES-IRP: Lower esophageal sphincter integrated relaxation pressure.