P0313 - Proposed Endoscopic Scoring System for Achalasia: The Delayed Esophageal Clearance in Achalasia (DECA) Score

Ashton Ellison, MBBCh, Anh Nguyen, MD, Chanakyaram “Shan” A. Reddy, MD, Rhonda Souza, MD, Stuart Spechler, MD, Vani Konda, MD
Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX

Introduction: While high resolution manometry is the gold standard test to diagnose achalasia, the findings need to be considered in the context of other tests such as esophagram, Functional Lumen Imaging Probe (FLIP) topography, and endoscopy. Presently, there is no standardized endoscopic scoring system for achalasia.

Methods: We devised an endoscopic scoring system with 4 components that might reflect delayed esophageal clearance: 1) retained contents in the esophagus 2) degree of esophageal body dilation 3) lower esophageal sphincter/esophagogastric junction (LES/EGJ) complex endoscopic appearance, and 4) degree of LES/EGJ resistance with endoscope passage. Each component was given a score of 0-3 for a total composite Delayed Esophageal Clearance in Achalasia (DECA) score of 0-12 (Table 1). A high DECA score suggests impaired esophageal clearance. To explore the value of our DECA system, we reviewed our esophageal motility database from December 2020 to March 2021 to identify patients who underwent upper endoscopy with FLIP topography. DECA score was calculated at the time of endoscopy by esophagologists and correlated with manometric findings and clinical diagnoses.

Results: Among 224 total patients in our database, 97 had complete data with no foregut surgery and qualified for inclusion. According to Chicago Classification v3.0 (v4.0 when available), 50 had no major motor disorder, 35 had EGJ outflow obstruction (EGJOO), 1 had diffuse esophageal spasm, 1 had absent contractility, 1 had hypercontractile esophagus and 9 had achalasia (1 type 1, 6 type 2, 2 type 3). Achalasia patients had a significantly higher mean DECA score than those with no major motility disorder (6.3 v 1.8, p = < 0.01). Among the achalasia subgroups, type 2 had the higher mean DECA score of 7.8; whereas, types 1 and 3 had the lower mean scores of 3 and 3.5, respectively. EGJOO also had a mean DECA score of 2.2, which was higher than those with no major motility disorder but did not reach statistical significance.

Discussion: The proposed DECA scoring system can be easily calculated at the time of endoscopy and high scores correlate with disorders associated with delayed esophageal clearance such as achalasia. While this scoring system requires additional validation, it allows for a standardized language in describing achalasia endoscopic findings which might be useful in pre- and post-treatment endoscopic assessment, as well as when evaluating other achalasia-like motility disorders such as EGJOO.



Disclosures:


Ashton Ellison, MBBCh, Anh Nguyen, MD, Chanakyaram “Shan” A. Reddy, MD, Rhonda Souza, MD, Stuart Spechler, MD, Vani Konda, MD. P0313 - Proposed Endoscopic Scoring System for Achalasia: The Delayed Esophageal Clearance in Achalasia (DECA) Score, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.