Skip to main content

Advertisement

SpringerLink
Log in

Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Achalasia outcome is primarily defined using the Eckardt score with failure recognized as > 3. However, patients experience many changes after myotomy including new onset GERD, swallowing difficulties, and potential need for additional treatment. We aim to devise a comprehensive assessment tool to demonstrate the extent of patient-reported outcomes, objective changes, and need for re-interventions following myotomy.

Methods

We performed a retrospective chart review of surgically treated primary achalasia patients. We identified 185 patients without prior foregut surgery who underwent either per oral endoscopic myotomy (POEM) or Heller myotomy from 2005 to 2017. Eight outcome measures in subjective, objective, and interventional categories formulated a global postoperative assessment tool. These outcomes included Eckardt score, Dakkak Dysphagia score, GERD–HRQL score, normalization of pH scores and IRP, esophagitis, timed barium clearance at 5 min, and the most invasive re-intervention performed.

Results

Of 185 patients, achalasia subtypes included Type I = 42 (23%), II = 109 (59%), and III = 34 (18%). Patients underwent minimally invasive myotomy in 114 (62%), POEM in 71 (38%). Median proximal myotomy length was 4 cm (IQR 4–5) and distal 2 cm (IQR 2–2.5). Based on postoperative Eckardt score, 135/145 (93%) had successful treatment of achalasia. But, only 47/104 (45%) reported normal swallowing, and 78/108 (72%) had GERD–HRQL score ≤ 10. Objectively, IRP was normalized in 48/60 (80%), whereas timed barium clearance occurred in 51/84 (61%). No evidence of esophagitis was documented in 82/115 (71%). Postoperative normal DeMeester scores occurred in 38/76 (50%). No additional treatments were required in 110/139 (79%) of patients.

Conclusions

Use of the Eckardt score alone to assess outcomes after achalasia surgery shows outstanding results. Using patient-reported outcomes, objective measurements, re-intervention rates, organized into a report card provides a more comprehensive and informative view.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Boeckxstaens GE, Zaninotto G, Richter JE (2014) Achalasia. Lancet 383(9911):83–93

    Article  Google Scholar 

  2. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, Patti MG, Ribeiro U, Richter J, Swanstrom L, Tack J, Triadafilopoulos G, Markar SR, Salvador R, Faccio L, Andreollo NA, Cecconello I, Costamagna G, da Rocha JRM, Hungness ES, Fisichella PM, Fuchs KH, Gockel I, Gurski R, Gyawali CP, Herbella FAM, Holloway RH, Hongo M, Jobe BA, Kahrilas PJ, Katzka DA, Dua KS, Liu D, Moonen A, Nasi A, Pasricha PJ, Penagini R, Perretta S, Sallum RAA, Sarnelli G, Savarin EO, Schlottmann F, Sifrim D, Soper N, Tatum RP, Vaezi MF, van Herwaarden-Lindeboom M, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Gittens S, Pontillo C, Vermigli S, Inama D, Low DE (2018) The 2018 ISDE achalasia guidelines. Dis Esophagus 31:1–29

    Article  Google Scholar 

  3. Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738

    Article  CAS  Google Scholar 

  4. Martinek J, Svecova H, Vackova Z, Radek D, Ngo O, Krajciova J, Kieslichova E, Janousek R, Pazdro A, Harustiak T, Zdrhova L, Loudova P, Stirand P, Spicak J (2018) Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc 32(3):1293–1302

    Article  Google Scholar 

  5. Boeckxstaens GE, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, Cuttitta A, Ilizalde I, Fumagalli U, Gaudric M, Rohof WO, Smouth AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, for the European Achalasia Trial Investigators (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364(19):1807–1816

    Article  CAS  Google Scholar 

  6. Raja S, Schraufnagel DP, Blackstone EH, Murthy SC, Thota PN, Thuita L, Lopez R, Gabbard SL, Ray MN, Wadhwa N, Sanaka M, Zanoni A, Rice TW (2019) Reintervention after Heller myotomy for achalasia: is it inevitable? Ann Thorac Surg 107(3):860–867

    Article  Google Scholar 

  7. Louie BE, Schneider AM, Schembre DB, Aye RW (2017) Impact of prior interventions on outcomes during per oral endoscopic myotomy. Surg Endosc 31(4):1841–1848

    Article  Google Scholar 

  8. Greene CL, Chang EJ, Oh DS, Worrell SG, Hagen JA, DeMeester SR (2015) High resolution manometry sub-classification of achalasia; does it really matter? Surg Endosc 29:1363–1367

    Article  Google Scholar 

  9. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, Pandolfino JE, International High Resolution Manometry Working Group (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27(2):160–174

    Article  CAS  Google Scholar 

  10. Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20(2):130–134

    Article  CAS  Google Scholar 

  11. Dakkak M, Bennett JR (1992) A new dysphagia score with objective validation. J Clin Gastroenterol 14(2):99–100

    Article  CAS  Google Scholar 

  12. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GNJ, Wallin L (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111(1):85–92

    Article  CAS  Google Scholar 

  13. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL (2014) A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg 259(6):1098–1103

    Article  Google Scholar 

  14. Ferri LE, Cools-Lartigue J, Cao J, Miller L, Mayrand S, Fried GM, Darling G (2010) Clinical predictors of achalasia. Dis Esophagus 23(1):76–81

    Article  CAS  Google Scholar 

  15. Urbach DR, Tomlinson GA, Harnish JL, Martino R, Diamant NE (2005) A measure of disease-specific health-related quality of life for achalasia. Am J Gastroenterol 100(8):1668–1676

    Article  Google Scholar 

  16. Kachala SS, Rice TW, Baker ME, Rajeswaran J, Thota PN, Murthy SC, Blackstone EH, Zanoni A, Raja S (2018) Value of routine timed barium esophagram follow-up in achalasia after myotomy. J Thorac Cardiovasc Surg 156(2):871–877

    Article  Google Scholar 

  17. Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henriquez A (2006) Very late results of esophagomyotomy for patients with achalasia. Ann Surg 243(2):196–203

    Article  Google Scholar 

  18. Gossage JA, Devitt PG, Watson DI, Myers JC, Jamieson GG, Thompson SK (2014) Surveillance endoscopy at five or more years after cardiomyotomy for achalasia. Ann Surg 259:464–468

    Article  Google Scholar 

  19. Tassi V, Lugaresi M, Daddi N, Mattioli S (2019) On the sequence gastro-esophageal reflux, esophagitis, Barrett’s esophagus, dysplasia, adenocarcinoma after Heller myotomy for the surgical therapy of esophageal achalasia [abstract]. In: 27th European Conference on General Thoracic Surgery, 2019, June 9-12; Dublin, Ireland: ESTS; 2019. Abstract nr O-054

Download references

Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA

    Ealaf Shemmeri, Ralph W. Aye, Alexander S. Farivar, Adam J. Bograd & Brian E. Louie

Authors
  1. Ealaf Shemmeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ralph W. Aye
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander S. Farivar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam J. Bograd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian E. Louie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian E. Louie.

Ethics declarations

Disclosures

Dr. Brian E. Louie receives educational grants from Boston Scientific, ERBE, and Olympus. Drs. Ralph W. Aye, Alexander S. Farivar, Adam J. Bograd, and Ealaf Shemmeri have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shemmeri, E., Aye, R.W., Farivar, A.S. et al. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc 34, 1856–1862 (2020). https://doi.org/10.1007/s00464-019-06952-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06952-2

Keywords

Search

Navigation