Ealaf Shemmeri, MD, Ralph W Aye, MD, Alexander S Farivar, MD, Adam Bograd, MD, Brian E Louie, MD. Swedish Thoracic Surgery
INTRODUCTION: 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 and potential need for additional treatment. We devised a report card to provide a comprehensive and informative assessment to document the scope of outcomes.
METHODS AND PROCEDURES: A retrospective single-center chart review from January 2005 to July 2017 identified 180 patients who underwent surgical palliation for primary achalasia. Variables were recorded 6 months to 15 years postoperatively with the most recent encounter accessed. Outcomes were grouped into three components: patient-reported symptoms, objective measurements, and rates of re-intervention. Success was defined for each metric based on achievement of known normal limits, current literature, and clinical judgment (Figure 1-Report Card). Swallowing function was assessed by Dakkak dysphagia score with higher score indicating better swallowing.
RESULTS: Of 180 patients, achalasia subtypes included: Type I=31 (17%), II=91 (51%), III=31 (17%) and variants=20 (11%). Patients underwent laparoscopic myotomy/partial fundoplication in 108 (60%), POEM in 70 (39%) and myotomy alone in 2 (1%). Median myotomy length was 6 cm (IQR=2-10). Based on postoperative Eckardt score, 120/125 (96%) had successful treatment of achalasia. But, only 37/84 (44%) reported normal swallowing, and 68/100 (68%) had GERD-HRQL score <10. Objectively, IRP was improved/normalized in 38/47 (81%) whereas timed barium clearance occurred in 55/87 (63%). No evidence of esophagitis was documented in 70/105 (67%) and postoperative normal DeMeester scores occurred in 39/70 (56%). No additional treatments were required in 99/124 (80%) of patients (Figure 1-Report Card).
CONCLUSIONS: Use of the Eckardt score to assess outcomes after achalasia surgery shows outstanding results, but may overinflate the true success of the operation. Using patient reported symptoms, objective measurements, and rates of re-intervention that are organized into a report card provides a comprehensive and informative view.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95359
Program Number: S085
Presentation Session: Foregut III
Presentation Type: Podium