Accuracy of Achalasia Quality of Life and Eckardt scores for assessment of clinical improvement post treatment for achalasia

Abstract

Achalasia Quality of Life (ASQ) and Eckardt scores are two patient-reported instruments widely used to assess symptom severity in achalasia patients. ASQ is validated and reliable. Although Eckardt is commonly used, it has not been rigorously assessed for validity or reliability. This study aims to evaluate (i) the accuracy of Eckardt and ASQ for assessing improvement post-treatment (predictive validity), (ii) accuracy of Eckardt and ASQ for assessing improvement post-treatment with pneumatic dilatation (PD) versus surgical myotomy (predictive validity), and (iii) convergent validity of Eckardt and ASQ tools. Patients with achalasia treated between 2011 and 2018 were eligible. Both instruments were administered by telephone. Treatment failure was determined by the review of medical records by two clinicians. The predictive ability of ASQ and Eckardt instruments in identifying treatment successes and failures was determined using receiver operating characteristics analysis and summarized as area under the curve (AUC). A total of 106 patients met inclusion criteria with 39 PD, 51 Heller myotomy, and 16 per-oral endoscopic myotomy. A review of medical records and esophageal testing revealed 13 failures (12%). AUC for Eckardt was 0.96 (95% confidence interval [CI] 0.87–0.99] and ASQ 0.97 (95% CI 0.92–0.99). The Eckardt cutoff 4, and ASQ, cutoff 15, were 94% and 87% accurate in identifying treatment successes versus failures, respectively. The correlation coefficient between the two tools was 0.85. In conclusions, (i) ASQ and Eckardt scores are valid and reliable tools to assess symptom severity in achalasia patients, (ii) both instruments accurately classify treatment successes versus failures, and (iii) the choice of tool should be informed by the physicians and patients’ values and preferences and repeat physiologic testing may be reserved for treatment failures with either instrument and patients classified, as treatment successes may be spared routine physiologic testing in the long term.

Symptomatic and Physiological Outcomes Following Laparoscopic Heller Myotomy for Achalasia Cardia: Is There a Correlation?

“…Very few studies have reported on correlation of ES with ASHRQoL and physiological parameters 4,23. In our study, a strong correlation was seen between ES and ASHRQoL ( r =0.41), similar to a recent study by Slone and colleagues with a correlation coefficient of 0.85 (95% confidence interval: 0.75-0.91).…”

Timed barium swallow for assessing long‐term treatment response in patients with achalasia: Absolute cutoff versus percent change – A cross‐sectional analytic study

“…Symptom improvement was based on post‐treatment clinic visits recorded in the chart by the senior author using a modified Eckardt scale or a telephone survey comparing the Eckardt scale 10 and the Achalasia Quality of Life scale 11 . Improvement was defined by an Eckardt scale of <4 12 …”

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“…The median pre-BSP Eckardt score was 9 (6-12), and decreased to 4 (2-6) after 1 month (P = 0.001), and maintained up to 9 years (2 [1][2][3]; P = 0.14). Dakkak score didnʼt show changes between pre-BSP and post-BSP 1-month and 2-month values; however, they improved at 3 months (pre-BSP = 4 [2][3][4] vs post-BSP 3 months = 1 0-2; P = 0.001), and values were maintained up to 9 years (post-BSP 3 months = 1 0-2 vs post-BSP 9 years = 2 0-2; P = 0.09).…”

“…At 1 month, we had six migrations, requiring a second stent placement, fixed with a median of three hemoclips (2)(3)(4). At 2 months all stents were in place.…”

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Esophageal achalasia is a primary esophageal motor disorder characterized by aperistalsis and failure in lower esophageal sphincter (LES) relaxation [1]. Treatment aim is to decrease LES pressure and integrated relaxation pressure (IRP), in order to improve symptoms and quality of life [2,3]. Laparoscopic Heller Myotomy (LHM) and Peroral endoscopic myotomy (POEM) are considered the gold standard of treatment [4][5][6]; however, safety is compromised in some populations, such as in elderly patients (adverse events of 2 % to 11.5 % in LHM and 5 % to 7.8 % for POEM [7][8][9]), representing high-risk procedures for them.

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