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

  • Author Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Xin-Yang Liu
    Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Author Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Jing Cheng
    Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Wei-Feng Chen
    Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Zu-Qiang Liu
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Yun Wang
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Mei-Dong Xu
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Shi-Yao Chen
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Yun-Shi Zhong
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Yi-Qun Zhang
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Li-Qing Yao
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Ping-Hong Zhou
    Correspondence
    Reprint requests: Quan-Lin Li, MD, or Ping-Hong Zhou, MD, FASGE, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
    Search for articles by this author
  • Quan-Lin Li
    Correspondence
    Reprint requests: Quan-Lin Li, MD, or Ping-Hong Zhou, MD, FASGE, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
    Affiliations
    Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Xin-Yang Liu, Jing Cheng, and Wei-Feng Chen contributed equally to this article.
Published:August 14, 2019DOI:https://doi.org/10.1016/j.gie.2019.07.036

      Background and Aims

      We aimed to establish a predictive model and develop a simple risk-scoring system (Zhongshan POEM Score) to help clinicians to characterize high-risk patients for clinical failure after peroral endoscopic myotomy (POEM).

      Methods

      A total of 1538 patients with achalasia 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. The system was then internally validated by survival analysis in the validation cohort.

      Results

      During 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: previous treatment (2 points), intraprocedural mucosal injury (2 points for type I and 6 points for type II), and clinical reflux (3 points). The patients were categorized into low-risk and high-risk groups. In the validation stage, Kaplan-Meier curves differed significantly between the 2 groups. Patients in the high-risk group had a significantly higher risk of clinical failure than those in the low-risk group (hazard ratio, 3.99; 95% confidence interval, 2.31-6.91; P < .001). Satisfactory discrimination and calibration were shown.

      Conclusions

      This risk-scoring system demonstrated good performance in predicting clinical failure in patients who underwent POEM.

      Graphical abstract

      Abbreviations:

      CI (confidence interval), HR (hazard ratio), LES (lower esophageal sphincter), POEM (peroral endoscopic myotomy), PPI (proton pump inhibitor)
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      Linked Article

      • Erratum
        Gastrointestinal EndoscopyVol. 93Issue 2
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          In the article, “A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy,” by Zhou et al, which was published in the January 2020 issue of GIE (Gastrointest Endosc 2020;91:33-40), there was an error in the text. The number of patients with technical failure was 17 instead of 4, therefore the total number of patients was 2370 instead of 2367. This error appears in both the text and in Figure 1.
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