Gastrointestinal endoscopy · 2026
Long-term external validation of the Japan Achalasia Multicenter Study Peroral Endoscopic Myotomy score reveals dynamic risk trajectories in achalasia patients after peroral endoscopic myotomy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li Meng, Hu Xinyan, Chen Yuxin, Liu Na, Huang Liang, Xu Yi, Bao Haibiao, Lyu Bin
Аннотация
BACKGROUND AND AIMS: The Japan Achalasia Multicenter Study Peroral Endoscopic Myotomy (JAMS POEM) score is a preoperative tool for predicting clinical failure after peroral endoscopic myotomy (POEM) in achalasia, yet its performance for long-term prognostication remains unclear. This study aimed to externally validate the JAMS POEM score and to characterize its predictive accuracy across short-, mid-, and long-term follow-up.
METHODS: We retrospectively analyzed prospectively collected data from consecutive achalasia patients who underwent POEM at a single tertiary center between 2012 and 2017. The JAMS POEM score was calculated from the pretreatment Eckardt score, prior treatment history, and manometric subtype. Clinical failure was defined as an Eckardt score of ≥4 or retreatment. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC) at short- (6 months), mid- (2-3 years), and long-term (≥8 years) follow-up. An exploratory 3-tiered stratification evaluated long-term failure trajectories.
RESULTS: A total of 94 patients (median follow-up 128.5 months) were included. The JAMS POEM score had good short-term discrimination (AUROC, 0.71; 95% CI, 0.56-0.87), but its long-term accuracy declined to 0.54 (95% CI, 0.42-0.67). The original binary classification showed limited long-term discrimination (10-year failure: low-risk 29.1% vs high-risk 37.5%). Exploratory 3-tiered stratification identified an intermediate-risk group with distinct progressive late failure (10-year rate 35.8%), contrasting with early failure in the high-risk group and stable course in the low-risk group.
CONCLUSIONS: The JAMS POEM score is reliable for short-term but not long-term prognostication. A 3-tiered stratification better captures long-term risk dynamics, identifying an intermediate-risk group warranting sustained surveillance.
METHODS: We retrospectively analyzed prospectively collected data from consecutive achalasia patients who underwent POEM at a single tertiary center between 2012 and 2017. The JAMS POEM score was calculated from the pretreatment Eckardt score, prior treatment history, and manometric subtype. Clinical failure was defined as an Eckardt score of ≥4 or retreatment. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUROC) at short- (6 months), mid- (2-3 years), and long-term (≥8 years) follow-up. An exploratory 3-tiered stratification evaluated long-term failure trajectories.
RESULTS: A total of 94 patients (median follow-up 128.5 months) were included. The JAMS POEM score had good short-term discrimination (AUROC, 0.71; 95% CI, 0.56-0.87), but its long-term accuracy declined to 0.54 (95% CI, 0.42-0.67). The original binary classification showed limited long-term discrimination (10-year failure: low-risk 29.1% vs high-risk 37.5%). Exploratory 3-tiered stratification identified an intermediate-risk group with distinct progressive late failure (10-year rate 35.8%), contrasting with early failure in the high-risk group and stable course in the low-risk group.
CONCLUSIONS: The JAMS POEM score is reliable for short-term but not long-term prognostication. A 3-tiered stratification better captures long-term risk dynamics, identifying an intermediate-risk group warranting sustained surveillance.