Post written by Ping-Hong Zhou, MD, from the Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

As a novel treatment approach for achalasia, POEM has achieved satisfactory long-term effectiveness. However, there are still around 10% of patients facing treatment failure, and there are currently no clinical predictive rules that could characterize high-risk patients.

The risk-scoring system we constructed demonstrated good performance in predicting clinical failure in patients who underwent POEM. Our risk-scoring system has several advantages. First, we included a large number of patients with a median follow-up of 42 months. This is the largest cohort of POEM with long-term follow-up data. In the present study, applying this risk-scoring system to the validation cohort revealed its accuracy and reliability. The predicted risk correlated well with the observed risk in low- and high-risk groups, and the high-risk patients had 3.99 times the hazard of clinical failure compared to low-risk patients. Therefore, this simple system could have good applicability in clinical settings. Another advantage of this risk-scoring system is that it is based on individual survival probabilities. We included clinical failure as a time-to-event covariate in the Cox regression model, with 2dimensions of information: whether the patient had clinical failure and time to clinical failure. This makes the prediction rule more accurate than just taking clinical failure as a binary covariate in logistic regression and ignoring the information about time. Moreover, this risk-scoring system is based on easily ascertainable clinical features and is thus easily adopted in clinical settings. Prospective and multicenter studies are warranted to further externally validate our findings.

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