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Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years' experience.

AbstractBACKGROUND AND STUDY AIMS:
This retrospective study reports 12 years' experience with pneumatic dilation treatment in patients with achalasia and attempts to define factors capable of predicting failure of endoscopic dilation.
PATIENTS AND METHODS:
Consecutive patients with achalasia who received endoscopic balloon dilation were studied retrospectively. Repeat dilation was carried out if dysphagia persisted or recurred. A structured symptom score questionnaire (the Eckardt score) was conducted by phone with patients who had received dilation and had been followed up for more than 2 years. Failure was defined as the presence of significant dysphagic symptoms after more than two repeat dilations. Data for the first 2 years (short-term) and for the subsequent follow-up (long-term) were analyzed.
RESULTS:
From 1989 to 2001, 66 patients underwent endoscopic balloon dilation for achalasia; three perforations (4.5 %) occurred, with no mortalities. Dysphagic symptoms significantly improved 12 weeks after the procedure ( P < 0.05). Fourteen patients (20 %) required a second dilation procedure within a median of 7 months (range 1 - 52 months), and 13 of them underwent repeat dilations within the first 2 years. Five patients (7.5 %) required further surgical or endoscopic therapy. Fifty-eight patients received pneumatic dilation for more than 2 years; 32 (55 %) responded to the questionnaire. The mean dysphagia score was 1.7 (SD 1.2), with only five patients (16 %) having significant dysphagic symptoms during a median follow-up period of 55 months (range 26 - 130 months). The cumulative success rates for pneumatic dilation after 5 and 19 years were 74 % and 62 %, respectively. Cox regression analysis identified small balloon size (30 mm) as the only significant factor capable of predicting failure of endoscopic dilation ( P = 0.009; relative risk 5.3; 95 % confidence interval, 1.7 to 40.9).
CONCLUSIONS:
Endoscopic balloon dilation is an effective treatment for achalasia, with minimal morbidity (60 % experience long-term benefit).
AuthorsK C Chan, S K H Wong, D W H Lee, W L M Mui, A C W Chan, E K W Ng, J C Y Wu, J J Y Sung, S C S Chung
JournalEndoscopy (Endoscopy) Vol. 36 Issue 8 Pg. 690-4 (Aug 2004) ISSN: 0013-726X [Print] Germany
PMID15280973 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Catheterization (methods)
  • Endoscopy, Gastrointestinal
  • Esophageal Achalasia (therapy)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Regression Analysis
  • Retrospective Studies
  • Treatment Outcome

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