Temporary self-expanding metallic stents and pneumatic dilation for the treatment of achalasia: a prospective study with a long-term follow-up

Abstract

The present study compares the efficacy of a self-expanding metallic stent (SEMS, diameter of 30 mm) and pneumatic dilation for the long-term clinical treatment of achalasia. A total of 155 patients diagnosed with achalasia were allocated for pneumatic dilation (n= 80, group A) or a temporary, 30-mm diameter SEMS (n= 75, group B). The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4-5 days after placement. Data on clinical symptoms, complications, and long-term clinical outcomes were collected, and follow-up observations were performed at 6 months and at 1, 3-5, 5-8, 8-10, and >10 years, postoperatively. Pneumatic dilation and stent placement were technically successful in all of the patients. There were no significant differences in technique success, 30-day mortality, or complications between the two groups. The clinical remission rate in group A was significantly lower than that in group B at 1, 1-3, 3-5, 5-8 and, >10 years (P < 0.05), while the cumulative clinical failure rate in group A (66%, 53/80) was higher than that in group B (92%, 6/75). The mean primary patency in group B was significantly longer than that in group A (4.2 vs 2.1 years, respectively; P < 0.001). A temporary, 30-mm diameter SEMS was associated with a better long-term clinical efficacy in the treatment of patients with achalasia as compared with treatment with pneumatic dilation.

Current Approach to the Treatment of Achalasia

“…A statistically significant reduction was observed in dysphagia, regurgitation, chest pain, and LES pressure in the expandable stent group compared to the pneumatic dilation group maintained through the end of the study at 10 years [28]. These findings are similar to two other recent studies [29,30], but differ from earlier pilot studies that suggested an unlikely future for stents in this disease [31]. Complications during these studies included stent migration (3%), although all stents were eventually removed endoscopically, chest pain (42%), and bleeding (16%).…”

Comparison of endoscopic balloon dilation with metal stent placement in the treatment of achalasia

“…Previous studies adopted a period of 3 to 7 days to remove the stents, and complications such as pain and bleeding occurred more frequently in the stent group than in the balloon dilation group . Short‐period SEMS placement was also associated with significantly higher clinical remission rates during the follow‐up periods . In our study we removed the stents one month after placement and no difficulties were encountered during the dislodging operation.…”

Achalasia: current treatment options

“…At least three Chinese series compared the efficacy and safety of esophageal SEMS versus PD in a large number of patients [72][73][74]. The overall results of all these series demonstrated a higher clinical remission rate with a 30 mm-SEMS compared to PD (83-89% vs 0-42%, respectively).…”

“…Over the last 15 years, some studies evaluated the efficacy and safety of the procedure [68][69][70][71], and some comparative trials versus PD are also available [72][73][74]. A variety of stent models have been used in the published series: differences included mesh design, presence of a covering and diameter.…”