Ethanolamine oleate as a novel therapy is effective in resistant idiopathic achalasia

Abstract

Idiopathic achalasia (IA) is a primary motor disorder of the esophagus. Recently, ethanolamine oleate (EO) has been introduced as a novel therapy in IA. We investigate the long-term efficacy of EO injection in the selected IA patients. Two hundred twenty patients with IA were evaluated prospectively. Thirty-one patients who were resistant to or poor candidate of pneumatic balloon dilation and/or cardiomyotomy were enrolled in this study. EO was injected into the lower esophageal sphincter three times at 2-week intervals. Patients were evaluated with the achalasia symptom score (ASS), timed barium esophagogram, and manometry before and after the injections. A good response was defined as a greater than 50% reduction from baseline in the ASS, height and/or volume of barium in TBE, and absence of severe dysphagia or regurgitation at 1.5 months after the last injection. Relapse was defined as two or more points increase in dysphagia score after an initial good response. The mean age of patients was 49.32 ± 19.3 years. Twenty-nine patients had a good response and two had a poor response. The mean ASS decreased from 12.48 (±2.06) to 4.50 (±2.96) (P = 0.0001), and the mean volume of barium decreased from 115.35 (±93.40) to 45.50 (±60.86) mL at 1.5 months after the last injection (P = 0.0001).The mean lower esophageal sphincter pressure was 30.47 ± 13.95 before the treatment and decreased to 14.30 ± 11.89 at 1.5 months after the treatment. (P = 0.0001). The mean duration of follow up was 30.16 ± 11.3 (18-68) months. Twelve patients in whom symptoms relapsed were treated effectively with reinjection. In some patients, minor complications (chest pain and erosion in the distal esophagus) occurred. This study indicates that EO has a long-term effect and can be considered for use in the selected IA patients.

Laparoscopic esophageal myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized controlled trials

“… 10 – 15 New options for achalasia peroral endoscopic myotomy (POEM), self-expanding metal stents, endoscopic sclerotherapy have shown promising results but there are only a few prospective observational studies to support their efficacy. 15 – 23 Current standard of care for achalasia includes forceful pneumatic dilation/balloon dilatation (PD/BD) and laparoscopic (Heller’s) esophageal myotomy (LEM) with or without an anti-reflux procedure. 15 There are some randomized controlled trials (RCTs) comparing the success rate (improvement of dysphagia) of these procedures at short-term follow-up, 8 , 24 – 26 but there are only 3 RCTs comparing the long-term outcomes at 5 years published till date.…”

Long-term Efficacy of Combined Treatment in Patients with Idiopathic Achalasia

“…Only minor adverse events occurred in this trial, and the authors concluded that EO injection could safely be used in the treatment of resistant idiopathic achalasia. 11 A small group of patients (nine patients) with achalasia were treated with the combined therapy (250 units of Dysport followed 7 days later with PBD). They were followed every 3 months, and the longest symptom improvement was 3 years.…”

Assessment of Pneumatic Balloon Dilation in Patients with Symptomatic Relapse after Failed Heller Myotomy: A Single Center Experience

“…A standard questionnaire was used for calculating the achalasia symptom score (ASS) as in our previous studies. 12 , 13 The severity of each symptom was recorded on a scale of 0 to 3, depending on its frequency. The total symptom score was the sum of five cardinal symptoms scores and the severity score of dysphagia ( tables 1 , and 2 ).…”