P0624 - Evaluation of CARS Score in Predicting Achalasia for Patients With Abnormal High Resolution Manometry (HRM) and Endoluminal Functional Lumen Imaging Probe (FLIP)

Award: ACG Presidential Poster Award

Priyanka K. Gill, MD¹, Yasmin Nasser, MD¹, Dorothy Li, MD¹, Michelle Buresi, MD¹, Christopher N. Andrews, MD, MSc², Matthew Woo, MD¹, Milli Gupta, MD, BSc¹
1University of Calgary, Calgary, AB, Canada; 2University of Calgary Cumming School of Medicine, Calgary, AB, Canada

Introduction: CARS score was developed to predict diagnosis of achalasia based on endoscopic features. CARS is comprised of Contents in esophagus, dilated Anatomy, Resistance of LES on passage of scope, and Stasis changes in the esophagus1. Patients with abnormal esophageal manometry (HRM) often get additional testing such as Endoluminal Functional Lumen Imaging Probe (FLIP) for further workup. We aimed to characterize the utility of CARS in making a diagnosis of achalasia in patients with abnormal HRM.

Methods: We conducted a retrospective cohort study of patients who underwent FLIP for abnormal HRM between December 2020 to December 2024. The primary outcome was a diagnosis of achalasia after all tests. The CARS score and manometric diagnosis were compared between patients with and without a diagnosis of achalasia after all tests. ROC analysis was performed to assess the performance of CARS in predicting achalasia. The association between CARS and FLIP metrics by Dallas criteria were explored. Finally, binary logistic regression analysis was performed to assess for predictors of achalasia.

Results: Of the 177 patients reviewed, 104 underwent FLIP for abnormal HRM results. A total of 83 patients (68 [82%] female) with a median age of 64 (IQR 22-89) were analyzed following exclusions for achalasia (11) and incomplete HRM (10). In terms of manometric diagnoses, 76 [91%] had EGJOO, 2 [2%] had hypercontractile esophagus, 2 [2%] had diffuse esophageal spasm, 2 [2%] had ineffective esophageal motility, and one [1%] had absent contractility. Based on FLIP, 14 (17%) were diagnosed with achalasia (13 had EGJOO and 1 had hypercontractile esophagus on HRM). CARS was significantly higher in patients diagnosed with achalasia after FLIP (median 2 [0-3] vs 0 [0-2]). CARS significantly correlated with FLIP distensibility and diameter metrics (Table 1). CARS predicted achalasia with a regression coefficient (B=1.78, 95% CI (2.49-14.1), p=< .001) after controlling for age, sex and manometric diagnosis. On ROC analysis, CARS predicted achalasia amongst patients without an HRM diagnosis of achalasia with an AUC 0.83 (Figure 1).

Discussion: CARS predicted achalasia amongst patients with abnormal HRM and correlated with various metrics in FLIP. This suggests CARS can play a key role in assessment of dysphagia patients. Further study of these associations in a prospective manner is needed to verify these results.


Figure: Figure 1: Area under the ROC curve


Figure: Table 1: Correlation between CARS Score (achalasia) and EndoFLIP Diagnostic Indices

Disclosures:
Priyanka Gill indicated no relevant financial relationships.
Yasmin Nasser indicated no relevant financial relationships.
Dorothy Li indicated no relevant financial relationships.
Michelle Buresi: Lupin Pharma, Sanofi/Regeneron, AVIR Pharmaceuticals, Bausch Health, Eli Lilly, Pfizer, Sandoz Canada – Advisory Committee/Board Member, Speakers Bureau.
Christopher Andrews: Abbvie – Advisor or Review Panel Member. Alimetry – Independent Contractor, Stock Options, Stock-privately held company. Avir – Advisor or Review Panel Member. Bausch Health – Advisor or Review Panel Member, Speakers Bureau. Knight Pharma – Advisor or Review Panel Member, Speakers Bureau. Nestle – Grant/Research Support. Nimble Science – Consultant, Stock Options, Stock-privately held company. Pendopharm – Advisor or Review Panel Member. Sanofi/Regeneron – Advisor or Review Panel Member. Takeda – Advisory Committee/Board Member.
Matthew Woo: Medtronic – Consultant, Speakers Bureau. Sanofi/Regeneron – Consultant, Speakers Bureau.
Milli Gupta: AstraZeneca – Consultant. AVIR Pharma Inc – Consultant. Bristol Myers Squibb – Grant/Research Support. Celldex – Grant/Research Support. Dr. Falk – Grant/Research Support. Eupraxia – Consultant, Grant/Research Support. Pentax – Consultant. Regeneron Pharmaceutical Inc. – Consultant. Sanofi – Consultant.

Priyanka K. Gill, MD¹, Yasmin Nasser, MD¹, Dorothy Li, MD¹, Michelle Buresi, MD¹, Christopher N. Andrews, MD, MSc², Matthew Woo, MD¹, Milli Gupta, MD, BSc¹. P0624 - Evaluation of CARS Score in Predicting Achalasia for Patients With Abnormal High Resolution Manometry (HRM) and Endoluminal Functional Lumen Imaging Probe (FLIP), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.