Skip to main content
SpringerLink
Log in

Role of modified Glasgow Prognostic Score in patients with achalasia who underwent laparoscopic Heller-myotomy with Dor-fundoplication

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

Systemic inflammatory response is significant prognostic indicator in patients with various diseases. The relationship between prognostic scoring systems based on the modified Glasgow Prognostic Score (mGPS) and achalasia in patients treated with laparoscopic Heller‑myotomy with Dor‑fundoplication (LHD) remains uninvestigated. This study aimed to examine the role of mGPS in patients with achalasia.

Methods

457 patients with achalasia who underwent LHD as the primary surgery between September 2005 and December 2020 were included. We divided patients into the mGPS 0 and mGPS 1 or 2 groups and compared the patients’ background, pathophysiology, symptoms, surgical outcomes, and postoperative course.

Results

mGPS was 0 in 379 patients and 1 or 2 in 78 patients. Preoperative vomiting and pneumonia were more common in patients with mGPS of 1 or 2. There were no differences in surgical outcomes. Postoperative upper gastrointestinal endoscopy revealed that severe esophagitis was more frequently observed in patients with mGPS of 1 or 2 (P < 0.01). The clinical success was 91% and 99% in the mGPS 0 and mGPS 1 or 2 groups, respectively (P < 0.01).

Conclusions

Although severe reflux esophagitis was more common in patients with achalasia with a high mGPS, good clinical success was obtained regardless of the preoperative mGPS.

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
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Alb:

Albumin

CRP:

C-reactive protein

GPS:

Glasgow Prognostic Score

LHD:

Laparoscopic Heller‑myotomy with Dor‑fundoplication

mGPS:

Modified Glasgow Prognostic Score

NLR:

Neutrophil/Lymphocyte Ratio

PLR:

Platelet/Lymphocyte Ratio

PNI:

Prognostic Nutritional Index

POEM:

Peroral endoscopic myotomy

TBE:

Timed barium esophagogram

References

  1. Mayberry JF, Atkinson M. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am. 2001;11:235–48.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Katada N, Sakuramoto S, Yamashita K, Shibata T, Moriya H, Kikuchi S, et al. Recent trends in the management of achalasia. Ann Thorac Cardiovasc Surg. 2022;18:420–8.

    Article  Google Scholar 

  4. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

    Article  CAS  PubMed  Google Scholar 

  5. Costantini M, Salvador R, Capovilla G, Vallese L, Costantini A, Nicoletti L, et al. A thousand and one laparoscopic heller myotomies for esophageal achalasia: a 25-year experience at a single tertiary center. J Gastrointest Surg. 2019;23:23–35.

    Article  PubMed  Google Scholar 

  6. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.

    Article  ADS  CAS  PubMed  Google Scholar 

  7. McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39:534–40.

    Article  PubMed  Google Scholar 

  8. Jiang X, Hiki N, Nunobe S, Kumagai K, Kubota T, Aikou S, et al. Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer. Br J Cancer. 2012;107:275–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Zhao C, Ding C, Xie T, Zhang T, Dai X, Wei Y. Validation and optimization of the systemic inflammation-based modified glasgow prognostic score in predicting postoperative outcome of inflammatory bowel disease: preliminary data. Sci Rep. 2018;747:1–8.

    Google Scholar 

  10. Abacioglu OO, Koyunsever NY, Kilic S, Yildirim A, Kurt IH. Glasgow prognostic score as a marker of mortality after TAVI. Braz J Cardiovasc Surg. 2021;36:796–801.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jing X, Li C, Sun J, Peng J, Dou Y, Xu X, et al. Systemic inflammatory response markers associated with infertility and endometrioma or uterine leiomyoma in endometriosis. Ther Clin Risk Manag. 2020;11:403–12.

    Article  Google Scholar 

  12. Serra R, Ielapi N, Licastro N, Provenzano M, Andreucci M, Bracale UM, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as biomarkers for cardiovascular surgery procedures: a literature review. Rev Recent Clin Trials. 2021;16:173–9.

    Article  PubMed  Google Scholar 

  13. Hayashi J, Uchida T, Ri S, Hamasaki A, Kuroda Y, Yamashita A, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. 2020;68:774–9.

    Article  PubMed  Google Scholar 

  14. Japan Eshophageal Society. Descriptive rules for achalasia of the esophagus, june 2012. 4th edition. Esophagus. 2017;14:275–89.

    Article  Google Scholar 

  15. International High Resolution Manometry Working Group. The chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2015;27:160–74.

    Article  Google Scholar 

  16. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8.

    Article  CAS  PubMed  Google Scholar 

  17. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.

    Article  CAS  PubMed  Google Scholar 

  18. Legros L, Ropert A, Brochard C, Bouguen G, Pagenault M, Siproudhis L, et al. Long-term results of pneumatic dilatation for relapsing symptoms of achalasia after heller myotomy. Neurogastroenterol Motil. 2014;26:1248–55.

    Article  PubMed  Google Scholar 

  19. Fukushima N, Masuda T, Yano F, Omura N, Tsuboi K, Hoshino M, et al. Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance. Surg Endosc. 2021;12:6513–23.

    Article  Google Scholar 

  20. de Olivaira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, et al. Timed barium swallow: a simple technique for evaluatingesophageal emptying in patients with achalasia. AJR Am J Roentgenol. 1997;169:473–9.

    Article  Google Scholar 

  21. Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, et al. Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia. Surg Today. 2017;47:1339–46.

    Article  PubMed  Google Scholar 

  22. Lundell L, Dent J, Bennett J, Blum A, Armstrong D, Galmiche J, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Toiyama Y, Miki C, Inoue Y, Tanaka K, Mohri Y, Kusunoki M. Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med. 2011;2:95–101.

    Article  PubMed  Google Scholar 

  24. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89:1028–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hooper CE, Lyburn ID, Searle J. The South West Area Mesothelioma and Pemetrexed trial: a multicentre prospective observational study evaluating novel markers of chemotherapy response and prognostication. Br J Cancer. 2015;112:1175–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic infammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39:210–3.

    Article  CAS  PubMed  Google Scholar 

  27. Omura N, Kashiwagi H, Tsuboi K, Ishibashi Y, Kawasaki N, Yano F, et al. Therapeutic efects of a laparoscopic Heller myotomy and Dor fundoplication of the chest pain associated with achalasia. Surg Today. 2006;36:235–40.

    Article  PubMed  Google Scholar 

  28. Glick HA, Miyazaki T, Hirano K, Gonzalez E, Jodar L, Gessner BD, et al. One-year quality of life post-pneumonia diagnosis in Japanese adults. Clin Infect Dis. 2021;15:283–90.

    Article  Google Scholar 

  29. Tsuboi K, Yano F, Omura N, Hoshino M, Yamamoto SR, Akimoto S. Risk factors for the occurrence of peptic esophagitis following laparoscopic Heller-Dor surgery for esophageal achalasia. Dis Esophagus. 2022;35:1–10.

    Article  Google Scholar 

  30. Omura N, Yano F, Tsuboi K, Hoshino M, Yamamoto S, Akimoto S. Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus. 2018;15:217–23.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Naoko Fukushima, Takahiro Masuda, Kazuto Tsuboi, Masato Hoshino, Keita Takahashi, Masami Yuda, Yuki Sakashita, Hideyuki Takeuchi, Nobuo Omura, Fumiaki Yano & Ken Eto

Authors
  1. Naoko Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takahiro Masuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuto Tsuboi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masato Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keita Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masami Yuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuki Sakashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideyuki Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nobuo Omura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fumiaki Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ken Eto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoko Fukushima.

Ethics declarations

Ethical statement

This study was approved by the Ethics Committee of the Jikei University School of Medicine [30-238 (9259)], and all procedures were conducted in accordance with the Helsinki Declaration.

Conflict of interest

The authors have no conflicts of interest and funding to declare.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukushima, N., Masuda, T., Tsuboi, K. et al. Role of modified Glasgow Prognostic Score in patients with achalasia who underwent laparoscopic Heller-myotomy with Dor-fundoplication. Esophagus (2024). https://doi.org/10.1007/s10388-024-01047-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10388-024-01047-x

Keywords

Search

Navigation