Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2025; 31(17): 104579
Published online May 7, 2025. doi: 10.3748/wjg.v31.i17.104579
Effect of sex on the outcomes of peroral endoscopic myotomy for the treatment of achalasia
Chen-Yi Zhao, Ning Xu, Hao Dong, Ning-Li Chai, En-Qiang Linghu
Chen-Yi Zhao, Ning Xu, Hao Dong, Ning-Li Chai, En-Qiang Linghu, Department of Digestive Diseases, Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Chen-Yi Zhao and Ning Xu.
Co-corresponding authors: Ning-Li Chai and En-Qiang Linghu.
Author contributions: Linghu EQ contributed to conceptualization, methodology, resources, supervision, funding acquisition; Chai NL contributed to conceptualization, validation, writing review and editing, investigation, formal analysis; Zhao CY, Xu N contributed to validation, writing original draft, formal analysis; Dong H contributed to validation, investigation, formal analysis, writing review and editing.
Institutional review board statement: The study was approved by the Ethics Committee of the Chinese PLA General Hospital (No. S2021-239-01). The procedures used in this study were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: Informed consent was obtained from all cases prior to their inclusion in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The dataset generated and analyzed during the current study is available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Qiang Linghu, MD, Doctor, Department of Digestive Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Wanshoulu Street, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: December 25, 2024
Revised: March 22, 2025
Accepted: April 18, 2025
Published online: May 7, 2025
Processing time: 125 Days and 20.2 Hours
Abstract
BACKGROUND

Peroral endoscopic myotomy (POEM) has emerged as the first-line therapy for achalasia. However, large-scale studies which examine sex-related differences in symptoms and outcomes remain limited.

AIM

To evaluate the impact of sex on achalasia symptoms, diagnostic findings, and postoperative improvement following POEM.

METHODS

We conducted a retrospective review of achalasia patients who underwent POEM at a large center between 2010 and 2020, analyzing demographics and variables collected before, during, and after the procedure for both female and male cases.

RESULTS

Our study included 526 cases in total, with the female group experiencing more severe chest pain (P = 0.008). After stratifying age, we found that women aged 40 to 60 showed higher chest pain scores compared to their male counterparts. In female cases, the severity of dysphagia before POEM was lowest among those aged 60 and older (P = 0.033). Preoperatively, the integrated relaxation pressure (IRP) and resting lower esophageal sphincter pressure (LESP) were higher in the female group compared to the male group (P < 0.001 and P = 0.001, respectively). However, no differences in postoperative IRP and LESP were observed between two groups. The overall efficiency of POEM was 96.52%, with a significant improvement in chest pain scores noted in female cases (P = 0.043).

CONCLUSION

Sex may influence the severity and frequency of chest pain, with female cases exhibiting higher LESP and IRP compared to male cases. POEM is proven to be a safe and effective procedure for both sexes, with female cases potentially experiencing greater benefits.

Keywords: Sex difference; High-resolution esophageal manometry; Eckardt score; Peroral endoscopic myotomy; Achalasia

Core Tip: This is the first study that aimed to evaluate the impact of sex on achalasia symptoms, diagnostic findings, and postoperative improvement following peroral endoscopic myotomy (POEM). Our study drew a conclusion that sex may influence the severity and frequency of chest pain, with female cases exhibiting higher lower esophageal sphincter pressure and integrated relaxation pressure compared to male cases. POEM is proven to be a safe and effective procedure for both sexes, with female cases potentially experiencing greater benefits.