title: Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia.
abstract: Peroral endoscopic myotomy (POEM) is a novel treatment for achalasia with excellent outcomes. But the predictor for treatment failure is not well defined. This study was aimed to prospectively investigate the factors for predicting failed POEM.
  
  
  
  From June 2011 to May 2015, a total of 115 achalasia patients treated by POEM were included for the retrospective cohort study from Nanfang Hospital and the First People's Hospital of Yunnan Province. Patients were followed up with Eckardt score, high-resolution manometry and endoscope. POEM failure was defined as primary failure (Eckardt score failed to decrease to 3 or below) and recurrences (decrease of Eckardt score to 3 or below, then rise to more than 3) during one-year follow-up. Univariate and multivariate Cox regression analyses were performed to assess the predictive factor. For the associated factor, receiver operating characteristic curve (ROC) was utilized to determine the cutoff value of the predicting factor.
  
  
  
  The failure rate of POEM after 1 year was 7.0% (8/115), including 5 primary failure cases and 3 recurrences. Multivariate analysis showed higher pre-treatment Eckardt score was the single independent factor associated with POEM failure [9.5 (6-12) vs. 7 (2-12), odds ratio (OR) 2.24, 95 confidence interval (95% CI) 1.39-3.93, p = 0.001]. The cutoff value (Eckardt score ≥9) had 87.5 sensitivity (95% CI 47.3-99.7%) and 73.8% specificity (95% CI 64.4-81.9%) for predicting failed POEM.
  
  
  
  Pre-treatment Eckardt score could be a predictive factor for failed POEM. Eckardt score ≥9 was associated with high sensitivity and specificity for predicting POEM failure.
authors.affiliation: Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China.
authors.forename: Yutang
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.|Department of Gastroenterology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Gastroenterology, First People's Hospital of Yunnan Province, Kunming, China.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Fengping
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Zou
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Jianuan
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Gastroenterology, First People's Hospital of Yunnan Province, Kunming, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Silin
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China. drgwei@foxmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
mesh_terms: D000328:Adult; D002681:China; D016208:Databases, Factual; D004931:Esophageal Achalasia / Q000401:mortality / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000074433:Myotomy / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Achalasia; Eckardt score; Peroral endoscopic myotomy