A43 UTILITY OF A DIFFICULTY SCORE IN PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR TREATING ACHALASIA
Bibliographic record
Abstract
Achalasia, a primary esophageal motor disorder characterized by incomplete lower esophageal sphincter relaxation and loss of esophageal peristalsis, results in dysphagia, chest pain, regurgitation and weight loss. Peroral endoscopic myotomy (POEM) is a recently developed method of treating achalasia, less invasively than surgical myotomy. The objective of this study was to report the early outcomes of a series of patients treated with POEM in a single Canadian center and to assess the correlation between pre- and peri-operative factors and a POEM difficulty score (PDS). 29 consecutive patients with achalasia (16 men, 13 women, mean age 51.0 +/- 17.4, median duration of symptoms 60 mo [range 10 mo – 600 mo]) from a single tertiary center in Kingston, Ontario underwent 30 peroral endoscopic myotomies (POEM) between March 2016 and Sept 2017. A submucosal tunnel extending from the esophagus to the proximal stomach was created, and then a myotomy (mean length 14.6 ± 3.0 cm in the esophagus and 2.5 ± 0.81 cm in the cardia) of the circular muscle was performed. The mucosal incision was closed with hemostatic clips (median 5, range 4–6). The mean operating time was 92.1 ± 30.4 min. Pre- and post-operative assessments included Eckardt scores, timed barium esophagram, endoscopy and manometry. The median Eckardt score pre-procedure was 8 (range 4 - 12). 25 patients underwent follow-up (median duration 10 mo, range 2–18 mo) with post-procedure median Eckardt score of 1 (range 0 - 3). The improvement was statistically significant (Wilcoxon signed ranks p < 0.001). The reduction in integrated relaxation pressure (IRP) in 13 patients who underwent follow-up manometry was 13.2 +/- 8.9 mmHg (paired samples t-test p < 0.001). 57% (12/21) of patients who underwent follow-up EGD or 24h pH study had evidence of acid reflex. A difficulty score (POEM difficulty score), consisting of tunnel distension, submucosal oozing, submucosal fibrosis, spastic contractions and tunnel orientation was calculated. The median difficulty score for non-sigmoid (83%) was 1.5 (0–4) and for sigmoid morphology (17%) was 2.5 (1–5). The median difficulty score for type 1 achalasia (3%) was 1, type 2 achalasia (45%) was 1.5 (1 – 2.5) and type 3 achalasia (45%) was 2 (0 – 4). The PDS strongly correlated with POEM velocity (r=0.83) and this was significant (Spearman’s p < 0.001). There was no significant correlation with BMI, duration of disease or previous procedures. There were no complications. POEM is a safe, effective and durable method of managing achalasia. A difficulty score has been shown to correlate with POEM velocity and warrants further investigation. In the future, the PDS may be used to aid in the development of formal training protocol for POEM, in addition correlation with pre-procedural variables and post-procedure outcomes will be further investigated. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".