P0520 - The Validation of CARS Score for Prediction of Patients With Achalasia

Award: Presidential Poster Award

Meng Li, MD¹, Panyavee Pitisuttithum, MD², Eric Goudie, MD³, Kristjana Kristinsdottir, ⁴, Evandros Kaklamanos, ⁴, Mozziyar Etemadi, MD, PhD⁴, Ashton Ellison, MBBCh⁵, Anh D.. Nguyen, MD⁵, Chanakyaram A.. Reddy, MD⁵, Rhonda F.. Souza, MD⁵, Stuart J.. Spechler, MD⁵, Vani J.A.. Konda, MD⁵, Dustin A.. Carlson, MD，MS⁴, John E.. Pandolfino, MD^4
1The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China; Feinberg School of Medicine, Northwestern University,, Chicago, Illinois, Chicago, IL; ²Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, Chicago, IL; ³Université de Montréal; Feinberg School of Medicine, Northwestern University, Chicago, IL; ⁴Feinberg School of Medicine, Northwestern University, Chicago, IL; ⁵Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TX

Introduction: A novel endoscopic score system (CARS) was recently developed to predict achalasia based on grades of contents, anatomy, resistance, and stasis. We aimed to test the predictive power of CARS score in a large cohort of patients with esophageal symptoms.

Methods: Adults undergoing upper endoscopy and HRM for an indication of esophageal symptoms were included. The endoscopic video from each patient was carefully reviewed by 2 general gastroenterologists, and any disagreements were confirmed by one esophagologist to determine the CARS score. HRM diagnoses by CCv4.0 were collected for each patient.

Results: A total of 271 patients with no prior history of foregut surgery or esophageal interventions were included between August 2018 and July 2023. According to CCv4.0, patients were categorized as achalasia (n=89; Type 1=33, Type 2=46, Type 3=10), EGJOO (n=2), ineffective esophageal motility (IEM) (n=55), absent contractility (n=11), hypercontractile esophagus (n=5), distal esophageal spasm (DES) (n=7), and no motility disorder (n=102). Achalasia patients had a higher mean CARS score compared to those with no motility disorder (mean 4.5 vs 0.3, p = < 0.01). Absent contractility and IEM had a high CARS score compared to no motility disorder (mean 1.1 and 0.7 vs 0.3, p < 0.05). Sub-score analysis showed higher scores in Type 1 and Type 2 compared to Type 3 in terms of contents, anatomy and stasis (contents: mean 1.5 and 1.4 vs 0.9; anatomy: mean 1.2 and 1.0 vs 0.6; stasis: mean 0.9 and 0.8 vs 0.2, all p < 0.01). A composite CARS score of 4 or greater resulted in a sensitivity of 76.4%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 82.9% when comparing patients with achalasia and those with no motility disorder, and a sensitivity of 76.4%, specificity of 99.5%, PPV of 98.5%, NPV of 89.6% when comparing patients with achalasia and those with non-achalasia.

Discussion: The novel endoscopic CARS score provides high sensitivity and specificity in detecting achalasia. It has the potential to facilitate the timely and efficient diagnosis of achalasia and may reduce the necessity for manometry in certain scenarios.



Disclosures:


Meng Li, MD¹, Panyavee Pitisuttithum, MD², Eric Goudie, MD³, Kristjana Kristinsdottir, ⁴, Evandros Kaklamanos, ⁴, Mozziyar Etemadi, MD, PhD⁴, Ashton Ellison, MBBCh⁵, Anh D.. Nguyen, MD⁵, Chanakyaram A.. Reddy, MD⁵, Rhonda F.. Souza, MD⁵, Stuart J.. Spechler, MD⁵, Vani J.A.. Konda, MD⁵, Dustin A.. Carlson, MD，MS⁴, John E.. Pandolfino, MD⁴. P0520 - The Validation of CARS Score for Prediction of Patients With Achalasia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.