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

Abstract

BACKGROUND AND AIMS\nWe aimed to establish a predictive model and developed a simple risk-scoring system (Zhongshan POEM Score) to help clinicians to characterize high-risk patients for clinical failure after peroral endoscopic myotomy (POEM).\n\n\nMETHODS\nA total of 1,538 achalasia patients treated with POEM with available follow-up data were included in this study and were randomly classified to the training cohort (n=769) or internal validation cohort (n=769). A risk-scoring system was developed using multivariate Cox regression analysis in the training cohort. Next, the system was internally validated by survival analysis in the validation cohort.\n\n\nRESULTS\nDuring a median follow-up time of 42 months, 109 patients had clinical failure. In the training stage, 3 risk factors for clinical failure were weighted with point values: prior treatment (2 points), intraprocedural mucosal injury (2 points to type I and 6 points to type II), and clinical reflux (3 points). Then, the patients were categorized into low-risk and high-risk groups. In the validation stage, Kaplan Meier curves differed significantly between the 2 groups. High-risk patients had a significantly higher hazard of clinical failure compared with low-risk patients (hazard ratio, 3.99; 95% confidence interval, 2.31-6.91; P<0.001). Satisfying discrimination and calibration was shown.\n\n\nCONCLUSIONS\nThis risk-scoring system demonstrated good performance in predicting clinical failure in patients underwent POEM.