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Related Experiment Video

Updated: Feb 12, 2026

Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
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Muscle layer thickness affects the peroral endoscopic myotomy procedure complexity.

D Watanabe1, S Tanaka1, R Ariyoshi1

  • 1Department of Endoscopy, Kobe University Hospital, Chuo-ku, Kobe, Japan.

Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus
|April 5, 2018
PubMed
Summary

Thicker esophageal muscle layers in patients with esophageal motility disorders predict longer peroral endoscopic myotomy (POEM) procedure times. Preoperative endoscopic ultrasonography can assess POEM complexity.

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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.