352. ENDOSCOPIC SCORING SYSTEM FOR ACHALASIA PRE AND POST LOWER ESOPHAGEAL SPHINCTER INTERVENTION: THE DELAYED ESOPHAGEAL CLEARANCE IN ACHALASIA (DECA) SCORE. (24th September 2022)

• Record Type: Journal Article
• Authors: Ellison, Ashton; Nguyen, Anh D; Podgaetz, Eitan; "Shan" Reddy, Chanakyaram; Souza, Rhonda F; Spechler, Stuart J; Konda, Vani JA
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.352
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: While esophageal high-resolution manometry (HRM) is the gold standard test to diagnose achalasia, endoscopy findings can demonstrate impaired esophageal clearance. Presently, there is no standardized method to describe the severity of these findings. We developed a novel scoring system, the Delayed Esophageal Clearance in Achalasia (DECA) score, to describe achalasia findings on endoscopy. In this study, we seek to demonstrate that DECA scores, an objective marker of esophageal clearance, improve after peroral endoscopic myotomy (POEM). We reviewed the Baylor Scott and White Center for Esophageal Diseases patient database for patients who had both HRM and endoscopy performed between December 2020 and April 2021. Each patient had a DECA endoscopic score calculated based on four endoscopic findings at the time of endoscopy (Table 1). The medical records of patients who underwent a POEM with pre- and post- DECA scores between December 2020 to November 2021 were also reviewed. Patients with suspected or known achalasia were on a 1–5 day liquid diet prior to their endoscopic procedure. Among 254 patients in our database, 165 patients had no prior foregut surgery. Of the 165 surgical-naïve patients, 72 had an abnormal EGJ complex (EGJOO = 58, achalasia type 1 = 2, type 2 = 7, and type 3 = 5) with a mean DECA score of 5.9 (SD 2.4) in those with achalasia and 2.2 (SD 1.6) in EGJOO. There were 17 patients who underwent a POEM with a mean pre-POEM DECA score of 8.7 (SD 2.2) and a mean post-POEM DECA score of 3.2 (SD 2.2). The reduction in DECA score after POEM was statistically significant (p = <0.001). The DECA scoring system can be easily calculated at the time of endoscopy and allows for a standardized language in describing achalasia endoscopic finding especially in the pre- and post-treatment endoscopic assessment. In our study, we found a statistically significant difference in DECA score in patients pre and post POEM intervention.