The Clinical Value Of Endoscopic Ultrasonography Examination Pre And Post POEM Treatment In Patients With Esophageal Achalasia

Objective: To retrospectively analyze the clinical value of endoscopic ultrasonography(EUS)examination pre and post POEM(peroral endoscopic myotomy)in patients with esophageal achalasia(EA).Methods: From January 2018 to January 2021,esophageal EUS examination was performed in 33 patients with EA underwent POEM treatment(EA group)and 62 persons(without esophagus-related diseases)who needed gastric EUS examination(control group)in the same endoscopic center,in Yantai Yuhuangding Hospital affiliated to Qingdao University.The thickness of the muscularis propria layer and the circular muscle layer was measured at cardia,5cm,10 cm and 15 cm above cardia,and the ratio of circular muscle layer was calculated.Esophageal EUS was reviewed 3 months after POEM.The differences of muscular thickness in the same group and between the groups pre and post POEM were compared.To obtain the Eckardt score before POEM,three months and six months of follow-up after POEM.The differences of the Eckardt score(before POEM vs three months after POEM)and(before POEM vs six months after POEM)were compared.Results:(1)There was difference between EA group and control group in the thickness of muscularis propria layer(t=7.839,2.347,8.439),the circular muscle layer(t=10.598,10.596,11.293),the ratio of circular muscle layer(t=7.914,3.536,6.467),at gasrtic cardia,5cm and 10 cm above gasrtic cardia(all P<0.05 respectively).(2)The thickness of muscularis propria layer is not all equal at gasrtic cardia,5cm,10 cm and15cm above cardia in EA group(H=73.022,P < 0.001).The thickest of muscularis propria layer is the gasrtic cardia in EA group.There was no difference the gasrtic cardia vs 5cm above cardia in EA group in the thickness of muscularis propria layer(P>0.05).There was difference between(the gasrtic cardia vs 10 cm above cardia)and(the gasrtic cardia vs 15 cm above cardia)in EA group in the thickness of muscularis propria layer(P<0.05).There was difference between(5cm above cardia vs 15 cm above cardia)and(10cm above cardia vs 15 cm above cardia)in the thickness of muscularis propria layer(P<0.001).The thickness of the circular muscle layer is not all equal in EA group(H=77.230,P<0.001).The thickest of the circular muscle layer is the gasrtic cardia in EA group.There was no difference between(the gasrtic cardia vs 5cm above cardia)and(the gasrtic cardia vs 10 cm above cardia)in EA group in the thickness of the circular muscle layer(P>0.05).There was difference(the gasrtic cardia vs 15 cm above cardia),(5cm above cardia vs 15 cm above cardia)and(10cm above cardia vs 15 cm above cardia)in EA group in the thickness of the circular muscle layer(all P<0.001 respectively).(3)The thickness of muscularis propria layer is not all equal at gasrtic cardia,5cm,10 cm and 15 cm above cardia in control group(F=2.810,P < 0.05).There was difference between(the gasrtic cardia vs 15 cm above cardia)and(5cm above cardia vs 15 cm above cardia)in control group in the thickness of muscularis propria layer(P<0.05).The thickness of the circular muscle layer is not all equal in control group(F=5.688,P<0.05).There was difference(the gasrtic cardia vs 15 cm above cardia),(5cm above cardia vs15 cm above cardia)and(10cm above cardia vs 15 cm above cardia)in control group in the thickness of the circular muscle layer(all P<0.05 respectively).(4)There was difference pre and post POEM treatment in EA group in the thickness of muscularis propria layer(t=9.093,9.986,10.186),the circular muscle layer(t=8.888,9.664,9.370)and the ratio of circular muscle layer(t=6.313,4.324,4.867)at gasrtic cardia,5cm and 10 cm above gasrtic cardia(all P<0.05 respectively).(5)The end of follow-up time was January31,2021.Three months after POEM,thirty people have been followed up with the Eckardt score.The Eckardt score before POEM is 6.67±1.54.The Eckardt score of three months after POEM is 1.10±0.55.The difference value is 5.57 ± 1.43.There was difference(before POEM vs three months after POEM)(P<0.001);Six months after POEM,twenty-eight people have been followed up with the Eckardt score.The Eckardt score before POEM is 6.75±1.55.The Eckardt score of six months after POEM is1.11±0.57.The difference value is 5.64±1.45.There was difference(before POEM vs six months after POEM)(P<0.001).Conclusion:(1)Before POEM treatment,the structural characteristic of the esophagus for patient is to offer differential diagnosis information by observing endoscopic ultrasonography examination.The measurement of muscle thickness by endoscopic ultrasound examination has certain clinical guiding significance in establishing a tunnel and muscle incision during the operation.(2)After POEM treatment,endoscopic ultrasonography examination was performed to evaluate the esophageal muscle characteristics.The characteristics have certain clinical guiding significance for assessment its treatment effect.