An endoscopic scoring system for achalasia: the CARS score. Gastrointest Endosc 2024 Sep;100(3):417-428.e1
Date
03/03/2024Pubmed ID
38431105DOI
10.1016/j.gie.2024.02.020Scopus ID
2-s2.0-85201759685 (requires institutional sign-in at Scopus site) 22 CitationsAbstract
BACKGROUND AND AIMS: The diagnosis of achalasia is associated with an average delay of 2 years. Endoscopic features may prompt an earlier diagnosis. We aimed to develop and test a novel endoscopic score, CARS, for the prediction of achalasia.
METHODS: Part 1: Twenty endoscopic videos were taken from patients undergoing endoscopy for dysphagia or reflux. A survey with videos and endoscopic criteria options was distributed to 6 esophagologists and 6 general gastroenterologists. Inter-rater reliability (IRR) was measured and logistic regression was used to evaluate predictive performance. Three rounds of review were conducted to select the final score of 4 components. Part 2: A retrospective review was conducted for consecutive patients who had comprehensive esophageal testing. Each patient had a CARS endoscopic score calculated based on findings reported at endoscopy.
RESULTS: From a video review and analysis of score components, IRR ranged from 0.23 to 0.57 for score components. The final CARS score was selected based on the following 4 components: Contents, Anatomy, Resistance, and Stasis. In a mixed-effects model, the mean score across raters was higher for achalasia compared with nonachalasia subjects (4.44 vs 0.87; P < .01). In part 2 of the study, achalasia patients had a higher mean CARS score compared with those with no or ineffective motility disorder (mean 4.1 vs 1.3; P < .01).
CONCLUSIONS: We developed a CARS score based on reliability performance in a video-based survey and tested the score in a clinical setting. The CARS score performed well in predicting achalasia.
Author List
Ellison A, Peller M, Nguyen AD, Carlson DA, Keswani R, Schauer JM, Reddy CA, Souza RF, Spechler SJ, Pandolfino JE, Konda VJAAuthor
Matthew T. Peller MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Deglutition Disorders
Esophageal Achalasia
Esophagoscopy
Female
Gastroesophageal Reflux
Humans
Logistic Models
Male
Middle Aged
Observer Variation
Reproducibility of Results
Retrospective Studies
Video Recording
