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A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy

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Abstract

Background and aims

Peroral endoscopic myotomy (POEM) is a promising endoscopic technique for achalasia. We aimed to establish a regression model and develop a simple nomogram to predict the technical difficulty of POEM in a single center with large volume cases.

Methods

3385 achalasia patients treated with POEM were included, and the technical difficulty was systemically evaluated. All of them were randomized into the training cohort (n = 1693) or internal validation cohort (n = 1692). Then, the prediction model and nomogram were proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort.

Results

Of 3385 patients, technical difficulty happened in 417 (12.32%) cases. In the training stage, six factors were weighted based on the β coefficient from the regression model, including age, disease duration, sigmoid esophagus, mucosal edema, submucosal fibrosis, and tunnel length. The patients were categorized into low-risk (< 0.1), medium-risk (0.1–0.25), and high-risk (> = 0.25) groups. Our score model performed satisfying discrimination with the areas under the receiver-operating characteristic curve (AUC) of 0.743 (95% confidence interval (CI), 0.701–0.785) and calibration with goodness of fit in the Hosmer–Lemeshow test (P = 0.088) in internal validation.

Conclusions

The prediction model and nomogram demonstrated good performance in predicting the technical difficulty of POEM.

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Abbreviations

AUC :

Areas under the receiver–operator characteristic curve

CI :

Confidence interval

LES :

Lower esophageal sphincter

OR :

Odds ratio

POEM :

Peroral endoscopic myotomy

PPI :

Proton pump inhibitors

ROC :

Receiver operating characteristic

SD :

Standard deviation

References

  1. Richter JE (2010) Achalasia—an update. J Neurogastroenterol Motil 16(3):232–242

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Stavropoulos SN et al (2014) Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc 80(1):1–15

    Article  PubMed  Google Scholar 

  4. Teitelbaum EN et al (2014) Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg 18(1):92–98 ((discussion 98–9))

    Article  PubMed  Google Scholar 

  5. Bechara R et al (2019) Peroral endoscopic myotomy (POEM) for complex achalasia and the POEM difficulty score. Dig Endosc 31(2):148–155

    Article  PubMed  Google Scholar 

  6. Tan Y et al (2019) Difficult peroral endoscopic myotomy: definition and management strategies. Expert Rev Gastroenterol Hepatol 13(10):933–942

    Article  CAS  PubMed  Google Scholar 

  7. Wu QN et al (2017) Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures. Endoscopy 49(8):736–744

    Article  PubMed  Google Scholar 

  8. Chen WF et al (2015) Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc 81(1):91–100

    Article  PubMed  Google Scholar 

  9. Hosmer DW, Lemeshow S, Sturdivant RX (2013) Applied logistic regression, vol 398. Wiley, New York

    Book  Google Scholar 

  10. Tang X et al (2016) Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia. Surg Endosc 30(9):3774–3782

    Article  PubMed  Google Scholar 

  11. Watanabe D et al (2018) Muscle layer thickness affects the peroral endoscopic myotomy procedure complexity. Dis Esophagus. https://doi.org/10.1093/dote/doy009

    Article  PubMed  Google Scholar 

  12. Zhang XC et al (2016) Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy 48(11):967–978

    Article  PubMed  Google Scholar 

  13. Haito-Chavez Y et al (2017) Comprehensive analysis of adverse events associated with per oral endoscopic myotomy in 1826 patients: an international multicenter study. Am J Gastroenterol 112(8):1267–1276

    Article  PubMed  Google Scholar 

  14. Liu X et al (2021) Landscape of adverse events related to peroral endoscopic myotomy in 3135 patients and a risk-scoring system to predict major adverse events. Clin Gastroenterol Hepatol 19(9):1959-1966.e3

    Article  PubMed  Google Scholar 

  15. Wang Y et al (2019) Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc 89(4):769–778

    Article  PubMed  Google Scholar 

  16. Liu ZQ et al (2019) The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy. Endoscopy 51(4):307–316

    Article  CAS  PubMed  Google Scholar 

  17. Nabi Z et al (2018) Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases. Endoscopy 50(4):358–370

    Article  PubMed  Google Scholar 

  18. Yeniova AO et al (2021) Comparison of peroral endoscopic myotomy between de-novo achalasia and achalasia with prior treatment. Surg Endosc 35(1):200–208

    Article  PubMed  Google Scholar 

  19. Liu Z et al (2018) Comprehensive evaluation of the learning curve for peroral endoscopic myotomy. Clin Gastroenterol Hepatol 16(9):1420-1426.e2

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from the National Natural Science Foundation of China (Grant Nos. 82003074 and 82170555), Shanghai Rising-Star Program (Grant No. 19QA1401900), Major Project of Shanghai Municipal Science and Technology Committee (Grant No. 19441905200), and Chen Guang Program of Shanghai Municipal Education Committee (Grant No. 18CG07), and Shanghai “Rising Stars of Medical Talent” Youth Development Program (Youth Medical Talents—Specialist Program SHWJRS(2021)-99).

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Author notes

  1. Xin-Yang Liu, Zi-Han Geng, and Wei-Feng Chen shared co-first authorship.

Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China

    Xin-Yang Liu, Zi-Han Geng, Wei-Feng Chen, Mei-Dong Xu, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Li-Li Ma, Wen-Zheng Qin, Jian-Wei Hu, Ming-Yan Cai, Quan-Lin Li & Ping-Hong Zhou

  2. Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

    Xin-Yang Liu, Zi-Han Geng, Wei-Feng Chen, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Li-Li Ma, Wen-Zheng Qin, Jian-Wei Hu, Ming-Yan Cai, Quan-Lin Li & Ping-Hong Zhou

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  1. Xin-Yang Liu
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Contributions

PHZ and QLL created the concept and designed the project. XYL, ZHG, and WFC drafted the manuscript. All authors contributed substantially to all aspects of the article and revised versions.

Corresponding authors

Correspondence to Quan-Lin Li or Ping-Hong Zhou.

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Disclosures

Drs. Xin-Yang Liu, Zi-Han Geng, Wei-Feng Chen, Mei-Dong Xu, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Li–Li Ma, Wen-Zheng Qin, Jian-Wei Hu, Ming-Yan Cai, Quan-Lin Li, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose.

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Liu, XY., Geng, ZH., Chen, WF. et al. A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy. Surg Endosc 37, 2781–2788 (2023). https://doi.org/10.1007/s00464-022-09798-3

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  • DOI: https://doi.org/10.1007/s00464-022-09798-3

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