Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up

Abstract

Pneumatic dilation (PD) has been widely used in the treatment of idiopathic achalasia with a 70-90% response. The aim of this study was to evaluate the effectiveness of PD and its predictive factors by means of clinical assessment. In addition, we evaluated its safety and the need for subsequent surgical intervention. Fifty-six patients were treated with a Witzel dilator. The response was evaluated at medium (1-5 years) and long term (>5 years). Diverse possible predictive factors to response were analyzed. After the first PD, 85.7% of the 56 patients improved and passed from clinical stage II-III to clinical stage 0-I (P < 0.005). After the second dilation, 84.6% of the patients (13) passed to clinical stage 0-I (P < 0.05). Only patients who were not young (>40 years) avoided a second dilation and/or surgery (P < 0.001). During the first 5 years of follow-up, 80% of patients maintained their response; this percentage decreased to 58% after 10 years. PD therapy of achalasia is a safe technique, with few adverse effects (4% perforations and 10% gastroesophageal reflux). It offers a medium-term response of 80% and long-term response of around 60%. Age was the only predictive response factor.

Selected Commentary to "Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia"

“…Reflux was higher than previously reported in the PD group also [13], reaching 15%: this may reflect the careful design of the protocol, with 24-hour pH-monitoring performed a year after the treatment in all treated patients (as opposed to the symptom reporting or endoscopic evaluation of previous reports). On the other hand, it may also reflect the price to pay for the "aggressive" dilation protocol, involving repeated dilations if symptoms recurred.…”

Achalasia: A review of Western and Iranian experiences

“…The mean length of hospital stay and days off from work were significantly lower in the pneumatic dilation group; these were discovered to be 9 and 39 d in the myotomy group and 1 and 2 d in the pneumatic dilation group, respectively [57] . Some predictors for the outcome of pneumatic dilation have been sug g ested, including ag e of patients [68,69] and a decrease in LES pressure following dilation [69] . In a study of 111 patients, short-and longter m remission rates were good (98% and 75% at months 24 and 60, respectively), but young age (≤ 37.5 years), high esophageal body pressure, and high LES pressure (≥ 17.5 mmHg) following first dilation were negative predictive factors.…”

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

“…The major predictive factors for the failure of EBD treatment include young age (age < 40 years) [1,29], male gender, dilation by using a 30-mm balloon, presence of pulmonary symptoms, failure of treatment after one or two dilation sessions [27,30]. However, EBD is the most cost-effective treatment for achalasia for a period of 5 to 10 years after the procedures [13,31].…”