A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy

Zhou_headshot 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.


Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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