Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia

Tanaka, Yuriko; Iwakiri, Katsuhiko; Kawami, Noriyuki; Sano, Hirohito; Umezawa, Mariko; Kotoyori, Makoto; Hoshihara, Yoshio; Nomura, Tsutomu; Miyashita, Masao; Sakamoto, Choitsu

doi:10.1007/s00535-009-0145-4

Cited by 37 publications

(32 citation statements)

References 20 publications

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“…In our study, 1 session of PD was clinically effective in 67% of the patients, as Pneumatic balloon dilation in pediatric achalasia Di Nardo et al described in the majority of adult studies reporting an almost 80% success rate, with therapeutic effectiveness similar to that in patients undergoing surgery. 9,[31][32][33][34] Although there are reported perforation rates of 4% to 12% in adult patients, [10][11][12][13][14][15][16][17][18][19][20][21][22] no perforations have been documented in pediatric patients. [23][24][25][26][27][28][29][30] In our series, we did not observe serious complications, only self-limited postprocedural pain in 11% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several adult studies found that older age, female sex, a long history of symptoms before diagnosis, high pretherapeutic LES pressure, a postdilation LES pressure of less than 10 mm Hg, limited contrast retention on postdilation barium esophagram, and a higher number of repeated baseline PD dilations were associated with a favorable outcome for PD. [11][12][13][14][15][16][17][18][19][20][21][22] All of these studies were performed in adults, and often retrospectively. Experience with pediatric patients is limited to small retrospective series, [23][24][25][26][27][28][29][30] and possible predictive response factors have never been studied in the pediatric age group.…”

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confidence: 99%

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Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Nardo¹,

Rossi²,

Oliva³

et al. 2012

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Nardo¹,

Rossi²,

Oliva³

et al. 2012

Gastrointestinal Endoscopy

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“…Age was thought to be the only factor that determined the response to dilation [4,11,12]. Howard et al [13] reported that a young age at diagnosis and an increased esophageal width on barium swallows predicted a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…PD can result in remission in 67–90% of patients [3]. Tanaka et al [4] reported that old age was the only independent factor that was associated with the success of PD. In addition, Eckardt et al [5] showed that older age and lower post-therapy LES pressures were predictors of good treatment outcomes in patients treated with PD.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors Associated with the Success of Pneumatic Dilatation in Japanese Patients with Primary Achalasia: A Study Using High-Resolution Manometry

et al. 2013

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Background/Aims: A new classification of achalasia using high-resolution manometry (HRM) has recently been suggested. Pneumatic dilatation (PD) is a common treatment for primary achalasia. The usefulness of the new classification and HRM for the treatment and follow-up of patients after PD is unknown. The aim of this study was to evaluate the PD effectiveness and the predictive factors of success in Japanese patients with achalasia using HRM and the new classification of achalasia. Methods: Twenty-five patients were diagnosed with primary achalasia using HRM and treated by PD in our hospital. We evaluated symptom scores and esophageal manometry 6 and 12 months after the first PD. Results: After the first PD treatment, remission occurred in 24 out of 25 (96.0%) patients at 6 months and in 19 out of 25 (76.0%) patients at 12 months. With the new classification of achalasia, the success rates were 83.3, 80.0 and 50% for types I, II and III, respectively, 12 months after PD. The median age of the successful group was significantly greater than that of the failure group (47.1 vs. 37.0 years, p <0.05). The median residual lower esophageal sphincter (LES) pressure 6 months after PD in the successful group was significantly lower than that of the failure group (9.0 vs. 15.5 mm Hg, p <0.05). Conclusion: Good predictors of PD success were old age (>40 years) and residual LES pressures less than 15 mm Hg 6 months after PD.

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“…Apart from some of the above discussed studies, there are many other studies in literature which concluded old age as a predictor of favorable outcome 27-30. Though, the exact reason for this is not known, there are various hypotheses to explain this finding.…”

Section: Why Is Old Age a Favorable Predictor?mentioning

confidence: 98%

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

Ghoshal¹,

Murali²

2011

J Neurogastroenterol Motil

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Pneumatic dilation (PD) is an effective treatment for achalasia cardia. Outcome of PD, however, varies among different studies. Recently, some groups started considering laparoscopic myotomy to be competitive to PD in treatment of achalasia considering dreaded complication like perforation following the latter therapeutic approach. Therefore, there is need to predict outcome of PD for achalasia, so that appropriate therapy, both for treatment naïve and for treatment failed patients can be chosen. Apart from age and gender, 2 investigations, namely post-PD manometry and timed barium esophagogram are most often used to predict outcome after PD. Even though there are studies available in the literature with regard to these modalities to predict outcome of PD, these are quite few in number, including small number of patients, primarily because of rarity of the disease. In this article, we review the literature predicting outcome of PD for achalasia.

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Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia

Abstract: PD is a safe and effective treatment for achalasia, particularly in older patients who experience a better outcome than younger patients.

Cited by 37 publications

References 20 publications

Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Predictive Factors Associated with the Success of Pneumatic Dilatation in Japanese Patients with Primary Achalasia: A Study Using High-Resolution Manometry

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

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