ArticleSurgical endoscopy2026
Higher Area Deprivation Index scores predict incomplete pre-operative high-resolution manometry in Achalasia patients undergoing peroral endoscopic myotomy.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe Area Deprivation Index (ADI) is an important measure of neighborhood-level socioeconomic status (SES). Our study evaluates the correlation of ADI scores to post-operative clinic follow up compliance and completion of pre-operative high-resolution manometry (HRM) in patients with Achalasia undergoing Peroral Endoscopic Myotomy (POEM).
methodsWe conducted a retrospective cohort study of adult patients undergoing POEM at a single tertiary care center between March 2017 and December 2024 (N = 193). ADI was assigned using 2023 national rankings based on patient residential addresses. Analyses were restricted to patients with available ADI data (n = 181). Multivariable logistic regression was performed adjusting for age, travel distance, sex, body mass index (BMI), and smoking status.
resultsPatients who did not complete pre-operative HRM had higher ADI scores (89 [IQR 21]) compared to those who did (85 [IQR 29]), (p = 0.015). Patients who did not attend initial or overall post-operative follow-up also had higher ADI scores compared to those who completed follow-up. Median ADI was higher among patients with incomplete initial follow-up (90 [IQR 17] vs 85 [IQR 28]; p = 0.068) and overall follow-up (91 [IQR 18] vs 85 [IQR 27]; p = 0.064); however, these differences did not reach statistical significance on non-parametric testing. Mean values demonstrated similar patterns but were statistically significant on parametric analysis (p = 0.010 and p = 0.013, respectively). In multivariable logistic regression analysis, higher ADI rank was independently associated with increased odds of failing to complete pre-operative HRM (OR 1.04, 95% CI 1.01-1.07, p = 0.005). Age, travel distance, sex, BMI, and smoking status were not significantly associated with HRM completion (all p > 0.05).
conclusionPatients with higher ADI scores were less likely to complete HRM pre-operative testing. ADI scores can be used as a measure to risk stratify Achalasia patients undergoing POEM.
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