Muscular thickness of lower esophageal sphincter and therapeutic outcomes in achalasia: A prospective study using high-frequency endoscopic ultrasound
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
33
Journal Issue
1
Pages
240-248
Date Issued
2018
Author(s)
Li S.-W.
Chuah S.-K.
Abstract
Background and Aim: Patients with achalasia typically have thicker lower esophageal sphincter muscles, which can affect the distensibility of the esophagogastric junction. We aimed to assess whether these muscular features, measured using high-frequency endoscopic ultrasound, affect treatment outcomes. Methods: Consecutive adult patients with suspected achalasia were enrolled prospectively. They underwent a comprehensive diagnostic workup, including endoscopic ultrasound. The thickness of the lower esophageal sphincter, including the internal circular and outer longitudinal muscles, was measured using a 12-MHz ultrasonic miniprobe. Follow-up was performed at 1?month and then at 6-month intervals, after treatment. Treatment response was defined as a reduction in Eckardt score to ?3 or an improvement in the height of the timed barium esophagogram of ?50%. Results: Of the 29 patients who received pneumatic dilatation, all but one (96.6%) exhibited a good short-term treatment response. At an average follow-up time of 18.5 (12–55.5)?months, patients who had a mid-term recurrence after pneumatic dilatation had a significantly thicker outer longitudinal muscle (1.8 [1.5–1.8] vs 0.9 [0.8–1.7]?mm, P?=?0.036), but not internal circular muscle (2.0 [1.9–2.5] vs 2.1 [1.2–2.7]?mm, P?=?0.874) or total lower esophageal sphincter (3.7 [3.5–4.4] vs 3.6 [2.0–4.1] mm, P?=?0.362). Patients with an outer longitudinal muscle ?1.3?mm thick had a significantly lower mid-term remission rate than others (36.3% vs 100%, P?=?0.01). Conclusion: Thickening of the outer longitudinal muscle at the lower esophageal sphincter is associated with poor mid-term treatment outcomes for achalasia patients treated with pneumatic dilatation. ? 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd
SDGs
Other Subjects
barium; adult; aged; Article; balloon dilatation; clinical article; clinical feature; digestive system disease assessment; Eckardt score; endoscopic ultrasonography; esophagography; esophagus achalasia; female; follow up; high frequency endoscopic ultrasound; human; internal circular muscle; lower esophagus sphincter; male; muscle thickness; outcome assessment; outer longitudinal muscle; pneumatic balloon dilatation; priority journal; prospective study; remission; short course therapy; skeletal muscle; treatment response; diagnostic imaging; dilatation; esophagus achalasia; lower esophagus sphincter; middle aged; pathology; smooth muscle; treatment outcome; Adult; Aged; Dilatation; Endosonography; Esophageal Achalasia; Esophageal Sphincter, Lower; Female; Humans; Male; Middle Aged; Muscle, Smooth; Prospective Studies; Treatment Outcome
Type
journal article