Muscle layer thickness affects the peroral endoscopic myotomy procedure complexity

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Imaging

Background:

• Esophageal motility disorders cause significant symptoms like dysphagia and chest pain.
• The role of esophageal muscle layer thickness in these disorders and treatment outcomes is not well understood.
• Peroral endoscopic myotomy (POEM) is a treatment for these conditions.

Purpose of the Study:

• To determine the clinical significance of esophageal muscle layer thickness in patients undergoing POEM.
• To identify predictors of prolonged POEM procedure duration.

Main Methods:

• Prospective study of 74 patients with esophageal motility disorders undergoing POEM.
• Analysis of esophageal muscle layer thickness (≥1.5 mm vs. <1.5 mm).
• Multivariate logistic regression to identify predictors of longer procedure time.

Main Results:

• A thicker esophageal muscle layer (≥1.5 mm) was associated with significantly longer POEM procedure times.
• The relative frequency of longer POEM procedures (≥78 min) was higher in patients with thicker muscle layers (66.7% vs. 19.5%).
• Thick esophageal muscle layer and myotomy length were independent predictors of longer POEM procedures.

Conclusions:

• Esophageal muscle layer thickness is a significant factor influencing POEM procedure duration.
• Preoperative assessment of muscle thickness using endoscopic ultrasonography can predict the technical complexity of POEM.
• This information aids in surgical planning and patient management.