Long-term outcome of a modified balloon dilatation in the treatment of patients with achalasia

Doder, Radoje; Perišić, Nenad; Tomašević, Ratko; Mirković, Darko; Janković, Zoran; Djordjevic, Zoran

doi:10.2298/vsp110505015d

Cited by 4 publications

(6 citation statements)

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“…The gender of patient was not associated with failure of dilatation and the same appears in most studies 4,5,8 .…”

Section: Discussionsupporting

confidence: 75%

“…Modified BD was performed with Rigiflex balloon dilator (Boston Scientific USA) without sedation up to the pain threshold of patients 4 . In 44 patients one BD was performed and in 8 patients two BD were done due to relapse of disease (7) and dilatation failure (1).…”

Section: Methodsmentioning

confidence: 99%

“…Dvofazna scintigrafija jednjaka u ležećem/stojećem položaju je najpogodnija metoda za of treatment is primarily to relief the dysphagia. The most frequent therapeutic method is pneumatic balloon dilatation (BD) which alleviate transit through the LES and leads to long remission in most of patients [3][4][5][6][7][8] . Some patients are subjected to failed dilatation or to shorter or longer period ending with disease relapse.…”

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confidence: 99%

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Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

et al. 2021

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Background/Aim. The purpose of this paper is to present the results of esophageal scintigraphy (ES) in achalasia treated by balloon dilatation (BD) for a long period of time between years 1997 and 2016 and to set parameters suitable for prediction of treatment outcomes. Methods. Two-phase ES in anterior projection was performed. The first phase involved swallowing 10 ml of water with 18.5 MBq 99m Tc in supine position. The second phase was performed in standing position after swallowing 100 ml of water. Retention index (RI) of esophageal radioactivity was calculated after the imaging using registered esophageal and gastric counts. ES was performed in 52 patients (34 male and 18 female, aged 22-75 years, median patient age of 44 years) before and after BD. In 32 patients only two scintigraphies were performed. In remaining 20 patients follow-up and repeated scintigraphies were continued including the patients with therapeutic failure and repeated BD. BD was repeated in 8 patients and those were followed up and evaluated over time.Modified BD was performed with Rigiflex balloon dilators. Results. Typical scintigraphic finding in supine position was passive esophageal filling without evidence of motility and in most of patients (43) absent radionuclide elimination to stomach (83%). Evaluating values before and longer after the first BD it has been shown that certain values of RI indicate remission or relapse of disease. The RI difference more than 50% after BD was a reliable indicator of longer remission The age and gender of patients had no impact on dilatation outcome but younger patients were with higher risk of early failure (6 patients during first year after BD). ES showed that the first BD was successful initially in 50 patients and after follow-up in 42 patients (81%). Conclusion. Two-phase supine/standing esophageal scintigraphy is most suitable for diagnosing and follow-up of achalasia.Retention index represents an important parameter for evaluation and prediction of therapeutic response. The RI difference more than 50% after BD is a reliable predictor of longer remission. Age and gender have no impact on dilatation outcome but patients younger than 40 years are with higher risk of early therapeutic failure.

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“…The gender of patient was not associated with failure of dilatation and the same appears in most studies 4,5,8 .…”

Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

et al. 2021

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“…748 records were screened, and 88 full-length articles were assessed. Sixty-six studies 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 were included in the final analysis, four of which directly compared outcomes of POEM to PD 32 35 36 38 . A total of 29 studies reported on the outcomes of POEM 24 …”

Section: Resultsmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

et al. 2021

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Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

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“…Balloon dilatation implicates balloon inflation at the level of esophageal and gastric junction with resulting rupture of muscle fibers, with preservation of esophageal mucosa. Success rate for this procedure is 80%, according to the study by Doder et al [10] and esophageal perforation is noted in 5% of patients, which requires urgent surgical intervention [11]. Surgical method of choice is Heller's myotomy with partial fundoplication.…”

Section: Discussionmentioning

confidence: 99%

"Stray" achalasia: From gastroenterologist to pulmonologist and back

et al. 2016

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Long-term outcome of a modified balloon dilatation in the treatment of patients with achalasia

Abstract: Modified balloon dilatation can be recommended for initial method in achalasia treatment due to high efficacy, easy performance in daily hospital while complications are in standard range.

Cited by 4 publications

References 42 publications

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

"Stray" achalasia: From gastroenterologist to pulmonologist and back

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