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Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia

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Abstract

Background

Peroral endoscopic myotomy (POEM) is a novel treatment for achalasia with excellent outcomes. But the predictor for treatment failure is not well defined. This study was aimed to prospectively investigate the factors for predicting failed POEM.

Methods

From June 2011 to May 2015, a total of 115 achalasia patients treated by POEM were included for the retrospective cohort study from Nanfang Hospital and the First People’s Hospital of Yunnan Province. Patients were followed up with Eckardt score, high-resolution manometry and endoscope. POEM failure was defined as primary failure (Eckardt score failed to decrease to 3 or below) and recurrences (decrease of Eckardt score to 3 or below, then rise to more than 3) during one-year follow-up. Univariate and multivariate Cox regression analyses were performed to assess the predictive factor. For the associated factor, receiver operating characteristic curve (ROC) was utilized to determine the cutoff value of the predicting factor.

Results

The failure rate of POEM after 1 year was 7.0% (8/115), including 5 primary failure cases and 3 recurrences. Multivariate analysis showed higher pre-treatment Eckardt score was the single independent factor associated with POEM failure [9.5 (6–12) vs. 7 (2–12), odds ratio (OR) 2.24, 95 confidence interval (95% CI) 1.39–3.93, p = 0.001]. The cutoff value (Eckardt score ≥9) had 87.5 sensitivity (95% CI 47.3–99.7%) and 73.8% specificity (95% CI 64.4–81.9%) for predicting failed POEM.

Conclusions

Pre-treatment Eckardt score could be a predictive factor for failed POEM. Eckardt score ≥9 was associated with high sensitivity and specificity for predicting POEM failure.

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References

  1. Richter JE, Boeckxstaens GE (2011) Management of achalasia: surgery or pneumatic dilation. Gut 60:869–876

    Article  PubMed  Google Scholar 

  2. Kashiwagi H, Omura N (2011) Surgical treatment for achalasia: when should it be performed, and for which patients? Gen Thorac Cardiovasc Surg 59:389–398

    Article  PubMed  Google Scholar 

  3. Gockel HR, Schumacher J, Gockel I, Lang H, Haaf T, Nothen MM (2010) Achalasia: will genetic studies provide insights? Hum Genet 128:353–364

    Article  CAS  PubMed  Google Scholar 

  4. Ahmed A (2008) Achalasia: what is the best treatment? Ann Afr Med 7:141–148

    Article  PubMed  Google Scholar 

  5. Inoue H, Santi EG, Onimaru M, Kudo SE (2014) Submucosal endoscopy: from ESD to POEM and beyond. Gastrointest Endosc Clin N Am 24:257–264

    Article  PubMed  Google Scholar 

  6. Pasricha PJ, Hawari R, Ahmed I, Chen J, Cotton PB, Hawes RH, Kalloo AN, Kantsevoy SV, Gostout CJ (2007) Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 39:761–764

    Article  CAS  PubMed  Google Scholar 

  7. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271

    Article  CAS  PubMed  Google Scholar 

  8. Bechara R, Ikeda H, Inoue H (2015) Peroral endoscopic myotomy: an evolving treatment for achalasia. Nat Rev Gastroenterol Hepatol 12:410–426

    Article  PubMed  Google Scholar 

  9. Werner YB, Costamagna G, Swanström LL, von Renteln D, Familiari P, Sharata AM, Noder T, Schachschal G, Kersten JF, Rösch T (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65:899–906

    Article  PubMed  Google Scholar 

  10. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE (2015) International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders v3.0. Neurogastroenterol Motil 27:160–174

    Article  CAS  PubMed  Google Scholar 

  11. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725

    Article  PubMed  Google Scholar 

  12. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256:659–667

    Article  PubMed  Google Scholar 

  13. Talukdar R, Inoue H, Nageshwar Reddy D (2015) Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29:3030–3046

    Article  PubMed  Google Scholar 

  14. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  PubMed  Google Scholar 

  15. Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanström LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833

    Article  PubMed  Google Scholar 

  16. Gaissert HA, Lin N, Wain JC, Fankhauser G, Wright CD, Mathisen DJ (2006) Transthoracic Heller myotomy for esophageal achalasia: analysis of long-term results. Ann Thorac Surg 81:2044–2049

    Article  PubMed  Google Scholar 

  17. Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD (2009) Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 146:826–831

    Article  PubMed  Google Scholar 

  18. Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738

    Article  CAS  PubMed  Google Scholar 

  19. Gockel I, Junginger T (2007) The value of scoring achalasia: a comparison of current systems and the impact on treatment–the surgeon’s viewpoint. Am Surg 73:327–331

    CAS  PubMed  Google Scholar 

  20. Chen WF, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Ma LL, Qin WZ, Hu JW, Cai MY, He MJ, Cui Z (2015) Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc 81:91–100

    Article  PubMed  Google Scholar 

  21. Youssef Y, Richards WO, Sharp K, Holzman M, Sekhar N, Kaiser J, Torquati A (2007) Relief of dysphagia after laparoscopic Heller myotomy improves long-term quality of life. J Gastrointest Surg 11:309–313

    Article  PubMed  Google Scholar 

  22. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL (2013) Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc 77:719–725

    Article  PubMed  Google Scholar 

  23. Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Boris L, Nicodème F, Lin Z, Hungness ES (2014) An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc 28:2840–2847

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kadakia SC, Wong RK (1993) Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenteol 88:34–38

    CAS  Google Scholar 

  25. Kim CH, Cameron AJ, Hsu JJ, Talley NJ, Trastek VF, Pairolero PC, O’Connor MK, Colwell LJ, Zinsmeister AR (1993) Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc 68:1067–1073

    Article  CAS  PubMed  Google Scholar 

  26. Moon JT, Jung IS, Kim YS, Cho SH, Park H, Lee SI (2008) Correlation between clinical symptoms and radiologic findings before and after pneumatic balloon dilatation for achalasia. Korean J Gastroenterol 52:16–20

    PubMed  Google Scholar 

  27. Vaezi MF, Baker ME, Achkar E, Richter JE (2002) Timed barium oesophagogram: better predict of long term success after pneumatic dilation in achalasia than symptom assessment. Gut 50:765–770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sternbach JM, El Khoury R, Teitelbaum EN, Soper NJ, Pandolfino JE, Hungness ES (2015) Early esophagram in per-oral endoscopic myotomy (POEM) for achalasia does not predict long-term outcomes. Surgery 158:1128–1135

    Article  PubMed  Google Scholar 

  29. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135:1526–1533

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, Shiwaku H, Kunda R, Chiu P, Saxena P, Messallam AA, Inoue H, Khashab MA (2015) Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 3:E195–E201

    Article  PubMed  PubMed Central  Google Scholar 

  31. Khashab MA, Messallam AA, Onimaru M, Teitelbaum EN, Ujiki MB, Gitelis ME, Modayil RJ, Hungness ES, Stavropoulos SN, El Zein MH, Shiwaku H, Kunda R, Repici A, Minami H, Chiu PW, Ponsky J, Kumbhari V, Saxena P, Maydeo AP, Inoue H (2015) International multi-center experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc 81:1170–1177

    Article  PubMed  Google Scholar 

  32. Rhee K, Jeon H, Kim JH, Yoon YH, Park H, Lee SI (2013) An evidence of esophageal decompensation in patients with achalasia in the view of its subtype: a retrospective study. J Neurogastroenterol Motil 19:319–323

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shiino Y, Houghton SG, Filipi CJ, Awad ZT, Tomonaga T, Marsh RE (1999) Manometric and radiographic verification of esophageal body decompensation for patients with achalasia. J Am Coll Surg 189:158–163

    Article  CAS  PubMed  Google Scholar 

  34. Vaezi MF, Pandolfino JE, Vela MF (2013) ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 108:1238–1249

    Article  PubMed  Google Scholar 

  35. Hu JW, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Chen WF, Ma LL, Qin WZ, Cai MY (2015) Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc 29:2841–2850

    Article  PubMed  Google Scholar 

  36. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE (2015) J Am Coll Surg 221:256–264

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the grant from the National Natural Science Foundation of China (No. 81101610). The authors especially thank Jieqiong Zhou of Nanfang Hospital for her kind contributions to this investigation.

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Author notes

    Authors and Affiliations

    1. Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China

      Yutang Ren & Bo Jiang

    2. Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China

      Xiaowei Tang, Fengping Chen, Yingying Zou, Zhiliang Deng, Jianuan Wu, Silin Huang & Wei Gong

    3. Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China

      Xiaowei Tang

    4. Department of Gastroenterology, First People’s Hospital of Yunnan Province, Kunming, China

      Yanmin Chen & Yan Li

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    1. Yutang Ren
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    Correspondence to Wei Gong.

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    Yutang Ren, Xiaowei Tang, Yanmin Chen, Fengping Chen, Yingying Zou, Zhiliang Deng, Jianuan Wu, Yan Li, Silin Huang, Bo Jiang and Wei Gong declared no conflict of interests.

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    Yutang Ren, Xiaowei Tang and Yanmin Chen have contributed equally to this article.

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    Ren, Y., Tang, X., Chen, Y. et al. Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia. Surg Endosc 31, 3234–3241 (2017). https://doi.org/10.1007/s00464-016-5352-5

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