Morphologic Changes in Esophageal Body Movement During Bolus Transport After Peroral Endoscopic Myotomy in Type III Achalasia
김주성, 옹성문, 김지현, 이홍섭, 윤준식, 허대영,
소속 상세정보
김주성 ( Kim Alex Ju-Sung )
Inje University College of Medicine Department of Anatomy and Tumor Immunology
옹성문 ( Ong Sung-Moon )
Inje University Busan Paik Hospital Department of Internal Medicine
김지현 ( Kim Ji-Hyun )
Inje University Busan Paik Hospital Department of Internal Medicine
이홍섭 ( Lee Hong-Sub )
Inje University Busan Paik Hospital Department of Internal Medicine
윤준식 ( Yoon Jun-Sik )
Inje University Busan Paik Hospital Department of Internal Medicine
허대영 ( Hur Dae-Young )
Inje University College of Medicine Department of Anatomy and Tumor Immunology
Abstract
Background/Aims: The effect of peroral endoscopic myotomy (POEM) on esophageal body movement in achalasia is poorly understood. This study aims to evaluate morphological changes in esophageal body movement after POEM in type III achalasia by analyzing intraluminal ultrasound (US) images in comparison to type I and II achalasia.
Methods: Intraluminal US images and impedance values of the distal esophagus from 47 achalasia patients who underwent POEM or pneumatic dilatation (PD) (30 patients in the POEM group and 17 patients in the PD group) with pre- and post-procedural high-resolution impedance manometry and intraluminal US examinations were analyzed. The muscle thickness (MT), muscle cross-sectional area, lumen cross-sectional area (LCSA), contractility and distensibility indices, swallow-to-distension interval, and distension duration during each bolus transport were analyzed.
Results: The MT increased and LCSA decreased significantly (P < 0.001), but the contractility index was not improved after POEM or PD in type I achalasia. Baseline MT increased and LCSA decreased significantly after POEM and PD in type II achalasia (P < 0.001). In contrast, MT and the swallow-to-distension interval decreased and the distension LCSA/duration and contractility index increased after POEM in type III achalasia (P < 0.001). In contrast to type I and II achalasia, in type III achalasia, these effects were unique to the POEM group.
Conclusions: POEM decreased the esophageal LCSA by decreasing intrabolus pressure without improving contractility in type I and II achalasia. In contrast, POEM increased esophageal body distension and contractility and improved the inhibitory process during bolus transport in type III achalasia.
키워드
Body movement; Esophageal achalasia; Myotomy; Ultrasonography
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