Clinical Effect of Endoscopic Pneumatic Dilation for Achalasia

Abstract

Although pneumatic dilation is an accepted method for the treatment of achalasia, this therapy has high recurrence and complication rates, and prolonged follow-up studies on the parameters associated with various outcomes are rare. In this prospective 10-year follow-up study, a satisfactory therapeutic effect was achieved without serious complications. We report the therapeutic experience with pneumatic dilation, having aimed to evaluate the long-term clinical safety and efficacy of pneumatic dilation.In total, 35 consecutive patients with idiopathic achalasia who underwent pneumatic dilation were followed up at regular intervals in person or by a phone interview over a 10-year period. The mean duration of the follow-up was 43.03 ± 26.34 months (range 6–120 months). Remission was assessed by the dysphagia classification and symptom scores. Patients’ clinical symptom scores were calculated before and at 6 to 36 months, 37 to 60 months, and >60 months after therapy. The influence of the patients’ age, gender, and disease duration on the therapeutic effect was analyzed.The success rate of the operation was 97.2% (35/36), without massive hemorrhaging, perforation or other serious complications. Dysphagia after the therapy was significantly eased (P < 0.01). In total, 35 patients have been followed up for 6 to 36 months after therapy, 21 cases for 37 to 60 months, and 5 cases for >60 months, and the patients’ symptom scores separately decreased significantly compared with the pretherapy scores (P < 0.01). For these patients, the 6 to 36 months remission rate was 85.7% (30/35), the 37 to 60 months rate was 61.9% (13/21), and the >60 months rate was 40% (2/5). The dilation effect had no relationship to the patient's age, gender, and disease duration (P > 0.05). The patients in 30 cases (85.7%) were successfully treated with a single dilation, in 4 cases (11.4%) with 2 dilations, and in 1 case (2.9%) with 3 dilations.These results suggest that endoscopic pneumatic dilation is an achalasia therapy with a good response; it is a simple and safe procedure with long-term clinical effectiveness. It is a preferred method in the treatment of achalasia.

The 2018 ISDE achalasia guidelines

“…Achalasia recurrence may occur after any treatment although with variable rates. 42,65,99,101,102,104,[212][213][214][215][216][217][218][219][220][221][222][223][224][225][226] Achalasia recurrence is defined as the development of symptoms compatible with achalasia after initial improvement resulting from an endoscopic (BTI, PD, peroral esophageal myotomy (POEM)) or surgical intervention (laparoscopic or open myotomy). 42,214,227 Possible etiologies of recurrent symptoms include scarring across the myotomy, an incorrect or too tight fundoplication, GERD, peptic stricture, end-stage achalasia, and malignancy.…”

“…For example, patients undergoing first PD after confident diagnosis of achalasia may need a second dilatation (35 mm) and it may be logical to proceed with that, before undertaking further investigation. 104,153,227,228,233,236,42,65,99,101,102,[212][213][214][215][216][217][218][219][220][221][222][223][224][225][226] Symptom recurrence is not necessarily related to failure of achalasia therapy, and evaluation is required to determine the etiology of such symptoms. Recurrent symptoms may indicate recurrence of achalasia, but since no universal definition of recurrent achalasia exists and given the complexity of the disease, objective tests are warranted.…”

Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta‐analysis

“…Achalasia is a primary motor disease of the esophagus, manometrically characterized by loss of peristalsis and a non‐relaxing lower esophageal sphincter (LES) . The classic presentation is progressive dysphagia to both solids and liquids, often accompanied by regurgitation of undigested food and chest pain . On radiography, poor esophageal emptying and a very narrow LES are seen, and histopathology shows loss of neural cells in the myenteric plexus of the esophagus …”

Results of pneumatic dilation in treating achalasia: predictive factors

“…51 Late PD results have been reported in different study models. Some of these recent studies, 40,[52][53][54][55][56] with a long follow-up, after the use of the Rigiflex balloon, are shown in Table 3. It is generally observed that good responses sustained for more than 5 years appear in rates of at least 40% of cases.…”