Achalasia Endoscopic Visual Scale (Achalasia EVS): A Grading Method Predicting Long-term Outcome of Pneumatic Dilation in Patients with Achalasia

گوارش، مجله انجمن متخصصين گوارش و كبد ايران

دوره 16 - شماره Supple.1

Article Type: Original Article
Abstract: Introduction: Pneumatic dilation (PD) is a reasonable nonsurgical option for management of achalasia. Few methods have been used to predict long-term efficacy of PD but, with some limitations, hazards, and expenses. This study was designed to evaluate the potential of a new grading method, Achalasia Endoscopic Visual Scale (EVS), for predicting long-term outcome of PD in patients with achalasia. Method: In a prospective study, 65 patients with definite achalasia underwent PD, consecutively. Based on the amount of Mucosal Tearing (MT) after PD, patients were graded from 1to 4 and for lower esophageal sphincter opening (LES opening) fromA to D (LES doesn’t open by air insufflations to LES is open spontaneously without air insufflations with a diameter of 11 mm or more). A validated symptom score questionnaire were used before PD and one, six and twelve months after PD. Annual visits were performed thereafter in order to detect any symptom recurrence and need for re-intervention. Results:Sixty patients (58.3% female) with mean age of 39.9 ±18.9 years completed the study. The mean of symptom free survival of PD was 58.9±6.2 months (95% CI: 46.6-71.1) in all patients. Mean (95% CI) symptom free survival with MT grade 1 to 4 were 36.5±6.3 (24.1-49.0), 68.8±10.3 (48.5-89.1), 79.8±10.1 (59.8-99.8), and 30.0±0.0 months, respectively; P= 0.014. Mean symptom free survival based on LES opening grading of A to D were 30±4.2, 52.0±7.9, 53.6±8.2, and 51.4±7.0 months, respectively; p= 0.256. Conclusion: Achalasia EVS based on new MT classification is a strong independent predictor of long-term symptom free survival of PD. Multi-centric studies are required to find intra- and inter-observer variations of this grading system and to incorporate LES opening and clinical factors in formula for more precise prediction of the PD prognosis.
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