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首页> 外文期刊>Surgical Endoscopy >Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score
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Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score

机译：使用报告卡来评估贲门划分外科的结果：超越ECKARDT得分

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Background 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, swallowing difficulties, and potential need for additional treatment. We aim to devise a comprehensive assessment tool to demonstrate the extent of patient-reported outcomes, objective changes, and need for re-interventions following myotomy. Methods We performed a retrospective chart review of surgically treated primary achalasia patients. We identified 185 patients without prior foregut surgery who underwent either per oral endoscopic myotomy (POEM) or Heller myotomy from 2005 to 2017. Eight outcome measures in subjective, objective, and interventional categories formulated a global postoperative assessment tool. These outcomes included Eckardt score, Dakkak Dysphagia score, GERD-HRQL score, normalization of pH scores and IRP, esophagitis, timed barium clearance at 5 min, and the most invasive re-intervention performed. Results Of 185 patients, achalasia subtypes included Type I = 42 (23%), II = 109 (59%), and III = 34 (18%). Patients underwent minimally invasive myotomy in 114 (62%), POEM in 71 (38%). Median proximal myotomy length was 4 cm (IQR 4-5) and distal 2 cm (IQR 2-2.5). Based on postoperative Eckardt score, 135/145 (93%) had successful treatment of achalasia. But, only 47/104 (45%) reported normal swallowing, and 78/108 (72%) had GERD-HRQL score <= 10. Objectively, IRP was normalized in 48/60 (80%), whereas timed barium clearance occurred in 51/84 (61%). No evidence of esophagitis was documented in 82/115 (71%). Postoperative normal DeMeester scores occurred in 38/76 (50%). No additional treatments were required in 110/139 (79%) of patients. Conclusions Use of the Eckardt score alone to assess outcomes after achalasia surgery shows outstanding results. Using patient-reported outcomes, objective measurements, re-intervention rates, organized into a report card provides a more comprehensive and informative view.
机译：背景贲门失弛缓症的结果是使用ECKARDT比分失败视为主要定义> 3。然而，患者出现肌切开术经过多年的变化，包括新发GERD，吞咽困难，并为额外的治疗潜在需求。我们的目标是制定一个全面的评估工具来证明患者报告的结果，客观变化的重新干预下肌切开术的范围内，并需要。方法：我们进行了回顾性分析手术治疗贲门失弛缓症的主要患者。我们确定了185个例，恕不另行前肠手术谁在主观，客观要么接受每口腔内窥镜切开术（POEM）或Heller术从2005年到2017年八项成果的措施，以及介入的类别制定了全球术后评估工具。这些结果包括ECKARDT得分，Dakkak吞咽困难得分，GERD-HRQL得分，pH值分数和IRP，食道炎，定时钡在5分钟间隙的归一化，和最侵入性再次介入来执行。结果185名患者中，失弛缓症亚型包括类型I = 42（23％），II = 109（59％），和III = 34（18％）。例71（38％）经历了在114（62％）的微创肌切开术，POEM。中位数近侧肌切开术长度为4cm（IQR 4-5）和远端2厘米（IQR 2-2.5）。根据术后ECKARDT得分，135/145（93％）有贲门失弛缓症的治疗成功。但是，只有一百零四分之四十七（45％）报告正常吞咽，和一百零八分之七十八（72％）有GERD-HRQL得分<= 10，可客观，IRP在48/60（80％）进行归一化，而发生定时钡间隙在第51/84（61％）。食管炎的证据在一百一十五分之八十二（71％）的记录。发生在76分之38（50％）术后正常DeMeester分数。无需额外的处理是在139分之110（79％）需要的患者。在ECKARDT使用结论得分后独自贲门失弛缓症手术显示了优异成绩，以评估结果。使用患者报告的结果，客观的测量，再干预率，整理成一份报告卡提供了更为全面和翔实的看法。

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