Metal stents may represent an alternative
therapy in the treatment of
achalasia. We therefore evaluated the effectiveness of retrievable, fully covered
metal stents in patients with
achalasia. Fifty-nine patients with
achalasia were treated with retrievable, fully covered
metal stents. Symptoms using a global symptom score (0-10), lower esophageal sphincter (LES) resting pressure, LES relaxation, and simultaneous contraction of the esophagus were analyzed before and 1 week and 1 month after intervention. Complications and treatment outcomes were followed up at 6, 12, 18, and 24 months postoperatively.
Stent placement was successful, and clinical symptoms resolved (P < 0.01) in all patients. Regurgitation,
dysphagia and
chest pain improved significantly (all P < 0.01).
Therapy improved LES resting pressure (51.4 ± 9.7 mmHg pretherapy vs. 20.9 ± 8.1 mmHg post-
therapy), LES relaxation (58.1 ± 17.1% pretherapy vs. 84.5 ± 18.9% post-
therapy), and simultaneous contraction of the esophagus (36.1 ± 8.6% pretherapy vs. 69.4 ± 23.1% post-
therapy) 1 month after
stent placement (all P < 0.01). The cumulative clinical remission rates 6, 12, 18, 24, 30, and 36 months after
stent removal were 90.9%, 81.8%, 76.4%, 69.1%, 65.5%, and 49.1%, respectively. All patients tolerated
stent placement. Twelve patients (25.5%) complained of substernal
pain and five (10.6%) had substernal burning.
Stents migrated in four patients (8.5%). Insertion of retrievable, fully covered
metal stents is an effective and safe treatment in patients with
achalasia.