{
  "abstract": "Introduction Achalasia is a chronic esophageal motility disorder whose assessment traditionally relies on symptom-based scores, particularly the Eckardt score. This purely clinical approach fails to capture the full spectrum of disease severity, especially its biological and morphological dimensions. Preoperative C-reactive protein (CRP) reflects inflammation related to esophageal stasis, while esophageal dilatation represents anatomical progression. The aim of this study was to evaluate the relevance of a pre-POEM composite score integrating clinical, biological, morphological, and manometric parameters.Methods This was a prospective descriptive and analytical study including 33 patients who underwent POEM. The analyzed variables included preoperative CRP, esophageal dilatation, Eckardt score, achalasia subtype according to the Chicago Classification v4.0, and post-POEM complications.The composite score assigned points as follows: Eckardt score(0–3 = 0; 4–6 = 1; 7–9 = 2; 10–12 = 3), esophageal dilatation (absent = 0; present = 1), achalasia subtype (type III = 0; type II = 1; type I = 2), and CRP (<5 = 0; 5–10 = 1; >10 = 2). Correlations between the composite score and the different variables were evaluated.Results Thirty-three patients were included, with a median age of 39 years and a slight female predominance (51.5%). Type II achalasia was the most frequent subtype (60.6%).A significant positive correlation was observed between preoperative CRP and the pre-POEM composite score (Rho = 0.623; p < 0.001), suggesting that systemic inflammation is a relevant marker of global achalasia severity.Patients with esophageal dilatation had significantly higher composite scores than those without dilatation (5.30 ± 1.09 vs 3.00 ± 1.00; p = 0.045), highlighting the ability of the score to identify anatomically advanced disease.The correlation between the Eckardt score and the composite score was moderate but not statistically significant (r = 0.334; p = 0.057), underscoring the limitations of symptom-based assessment alone.The composite score varied significantly according to achalasia subtype (χ2 = 6.48; p = 0.039), with higher values observed in type II patients, reflecting more pronounced esophageal stasis and ineffective pan-esophageal pressurization.No significant association was found between the composite score and post-POEM complications (p > 0.05).Therapeutic success (Eckardt ≤ 3) was achieved in 100% of patients, confirming the safety and efficacy of POEM, even in severe forms of achalasia.Conclusions The pre-POEM composite score complements the Eckardt score and confirms that POEM remains safe and effective, even in patients with severe forms of achalasia, highlighting its role as a first-line treatment.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Docteur Meriem Amine"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Samir Mrabti"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Doctor Ahlame Benhamdane"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Doctor Salma Azammam"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Doctor Tarik Addajou"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Ilham El Koti"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Fedoua Rouibaa"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Mohamed V Military Teaching Hospital, Rabat, Morocco"
      ],
      "name": "Hassan Seddik"
    }
  ],
  "title": "P420 Pre-POEM composite score: an integrative tool to assess the global severity of achalasia",
  "uid": "b01f4839-03a2-514e-83d0-aa83eebd7ba9"
}