Risk scoring system for the preprocedural prediction of the clinical failure of peroral endoscopic myotomy: a multicenter case–control study

Hirofumi Abe; Shinwa Tanaka; Hiroki Sato; Yuto Shimamura; Hiroki Okada; Junya Shiota; Chiaki Sato; Hiroyuki Sakae; Masaki Ominami; Yoshitaka Hata; Hisashi Fukuda; Ryo Ogawa; Jun Nakamura; Tetsuya Tatsuta; Yuichiro Ikebuchi; Hiroshi Yokomichi; Haruhiro Inoue

doi:10.1055/a-1876-7554

Endoscopy, Table of Contents

Endoscopy 2023; 55(03): 217-224
DOI: 10.1055/a-1876-7554

Original article

Risk scoring system for the preprocedural prediction of the clinical failure of peroral endoscopic myotomy: a multicenter case–control study

Hirofumi Abe

¹Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

,

Shinwa Tanaka

¹Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

,

Hiroki Sato

²Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

,

Yuto Shimamura

⁴Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan

,

Hiroki Okada

⁵Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan

,

Junya Shiota

⁶Department of Gastroenterology & Hepatology, Nagasaki University Hospital, Nagasaki, Japan

,

Chiaki Sato

⁷Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

,

Hiroyuki Sakae

⁸Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

,

Masaki Ominami

⁹Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan

,

Yoshitaka Hata

¹⁰Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

,

Hisashi Fukuda

¹¹Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan

,

Ryo Ogawa

¹²Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan

,

Jun Nakamura

¹³Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

,

Tetsuya Tatsuta

¹⁴Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan

,

Yuichiro Ikebuchi

¹⁵Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago, Japan

,

Hiroshi Yokomichi

¹⁶Department of Health Sciences, University of Yamanashi, Yamanashi, Japan

,

Haruhiro Inoue

⁴Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan

› Author Affiliations

Abstract

Background Peroral endoscopic myotomy (POEM) is effective for the management of achalasia and its variants; however, it can be ineffective in some patients. We aimed to develop and validate a risk scoring system to predict the clinical failure of POEM preoperatively.

Methods Consecutive patients who underwent POEM in 14 high volume centers between 2010 and 2020 were enrolled in this study. Clinical failure was defined as an Eckardt score of ≥ 4 or retreatment. A risk scoring system to predict the short-term clinical failure of POEM was developed using multivariable logistic regression and internally validated using bootstrapping and decision curve analysis.

Results Of the 2740 study patients, 112 (4.1 %) experienced clinical failure 6 months after POEM. Risk scores were assigned for three preoperative factors as follows: preoperative Eckardt score (1 point), manometric diagnosis (−4 points for type II achalasia), and a history of prior treatments (1 point for pneumatic dilation or 12 points for surgical/endoscopic myotomy). The discriminative capacity (concordance statistics 0.68, 95 %CI 0.62–0.72) and calibration (slope 1.15, 95 %CI 0.87–1.40) were shown. Decision curve analysis demonstrated its clinical usefulness. Patients were categorized into low (0–8 points; estimated risk of clinical failure < 5 %) and high risk (9–22 points; ≥ 5 %) groups. The proportions of clinical failure for the categories were stratified according to the mid-term outcomes (log-rank test, P < 0.001).

Conclusions This risk scoring system can predict the clinical failure of POEM preoperatively and provide useful information when making treatment decisions.

Full Text

References

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Supplementary material