Long-Term Outcome of Pneumatic Dilation in the Treatment of Achalasia

Karamanolis, George; Sgouros, Spiros; Karatzias, Georgios; Papadopoulou, Efthimia; Vasiliadis, Konstantinos; Stefanidis, Gerasimos; Mantides, Apostolos

doi:10.1111/j.1572-0241.2005.40093.x

Cited by 137 publications

(101 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PD is easier to perform, and has the advantages of a shorter hospitalization and lower cost compared with surgery and had a better long-term efficacy than endoscopic botulinum toxin injection (9,11,12). The major concern of PD is that its long-term efficacy may not be that satisfactory (13,14). However, researchers have noticed an interesting fact: the recurrence rate after PD for achalasia inversely correlated with patient age, an older age is a favorable predictive factor for a good long-term efficacy (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence is a major concern after endoscopic and/or surgical treatment of achalasia, and several factors have been found to be associated with treatment failure, type III in HRM, young patients (< 40 years old), males had an unfavorable outcome in PD (2,11,13,25), and incomplete myotomy, an excessively tight anti-reflux wrap andsigmoid-type achalasia were associated with treatment failure in HM (26). In the present study, three cases had a recurrence, and multiple analysis revealed that sigmoid-type achalasia was a risk factor of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Background and aim: Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients.Methods: We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups.Results: A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up.Conclusion: Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

show abstract

“…A reduction of dysphagia in patients subjected to the above-mentioned procedure concerns 58-95% (15)(16)(17)(18)(19). The relatively low percentage of postoperative complications: mortality<1%, esophageal perforation 2-4%, reflux symptoms-5%, and low treatment costes speaks in favor of the procedure (14,(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

Kawiorski¹,

Popiela

Kibil

et al. 2007

Polish Journal of Surgery

View full text Add to dashboard Cite

Esophageal achalasia, one of the most common motor activity disturbances of the upper gastrointestinal tract, continues to pose a significant diagnostic and therapeutic problem, especially in patients with milder forms of the disease. The aim of the study was to evaluate and compare treatment results (pneumatic dilatation, cardiomyotomy) in patients with esophageal achalasia, as well as determine the usefulness of intraoperative, continuous manometric monitoring of the corrected segment of the "esophagogastric junction" (evaluation of myotomy). Material and methods. The study group comprised 104 patients, including 71 female and 33 male, treated at the Department during the period between 1997 and 2004. The mean patient age was 43.5 years, ranging between 19 and 75 years. The duration of the disease ranged between 5 months and 22 years. Every patient was subjected to endoscopy, histopathological, radiological and manometric examinations, before treatment. The therapeutic model was based on a two-staged management process. During the initial stage of therapy, patients were subjected to 2-3 pneumatic dilatations. A lack of response to treatment was considered treatment failure and these patients qualified for surgery -Heller's myotomy with antireflux treatment (fundoplication). Cachectic patients requiring immediate surgical intervention were excluded from the study. Results. Following pneumatic dilatation, good or very good results were obtained in 73 (70.2%) of the 104 patients. Procedures were repeated in only 8 (11%) patients, due to the recurrence of dysphagia. The remaining 31 (29.8%) patients underwent surgery with simultaneous intraoperative manometric control of the performed myotomy. Conclusions. Based on the obtained results, one can confirm the significant efficacy of pneumatic dilatation, which is considered the ultimate therapy. In the case of patients in whom we were not able to obtain good clinical results, one observed improved esophagogastric passage, which in turn improved nutritional parameters before planned surgical intervention. Intraoperative esophageal manometry enabled us to accurately evaluate the correctness of myotomy, which seemed to be an indispensable element in the prevention of disease recurrence.

show abstract

“…Pneumatic balloons are convenient for dilating the spastic cardiac sphincters forcefully and mechanically, leading to the partial rupture of smooth muscle fibers, but with definitive outcomes. Karamanolis et al [24] reported successfully treating 75.8% of their achalasia patients with one-course dilation, whereas only 1 patient developed a procedure-related complication (esophageal perforation). Additionally, the curative effects were still present in 51.4% of the dilated patients at the postoperative year 15 follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy of Pneumatic Dilation and Esophageal Stenting for the Treatment of Achalasia

Qian

Wang

et al. 2013

Digestion

View full text Add to dashboard Cite

Aims: To compare the efficacy and safety of pneumatic dilation with stenting for the treatment of achalasia. Methods: Achalasia patients treated with pneumatic dilation or stenting were included in this analysis. Clinical symptoms were assessed by the Eckardt score. An esophagram and esophageal manometry were performed at the pretreatment and posttreatment follow-up visits. Data such as patient demographics and complications were collected. A drop in the Eckardt score to ≤3 was defined as treatment success. Results: There were 151 patients treated with pneumatic dilation (n = 76) or stenting (n = 75). The 1-, 12- and 24-month therapeutic success rates were 100, 92 and 79%, respectively, in the dilation group and 100, 93 and 87%, respectively, in the stenting group. The decrease of Eckardt score in the stenting group was significantly notable (p < 0.05) compared to that of the dilation group at the long-term follow-up visits. The maximum esophageal diameter was comparable at baseline and became statistically significant [25 mm (22-30) vs. 22 mm (19-27), p = 0.004] at posttreatment month 24. The recurrence rate was 21% in the dilation group and 13% in the stenting group. The complications of either treatment were usually mild, transient and statistically insignificant. Conclusion: Esophageal stenting had a comparable short-term but better long-term efficacy in comparison with pneumatic dilation.

show abstract

Long-Term Outcome of Pneumatic Dilation in the Treatment of Achalasia

Abstract: Although 51.4% of patients continued to be in clinical remission more than 15 yr after the initial pneumatic dilation, the long-term success rate of pneumatic dilation seems to drop progressively with time.

Cited by 137 publications

References 23 publications

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

Long-Term Efficacy of Pneumatic Dilation and Esophageal Stenting for the Treatment of Achalasia

Contact Info

Product

Resources

About