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Outcomes of pneumatic dilation in achalasia: Extended follow‐up of more than 25 years with a focus on manometric subtypes
Author(s) -
Müller Michaela,
Keck Christina,
Eckardt Alexander J,
Werling Sarah,
Wehrmann Till,
König Jochem,
Gockel Ines
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14044
Subject(s) - achalasia , medicine , interquartile range , esophageal sphincter , cohort , single center , esophagus , demographics , gastroenterology , retrospective cohort study , surgery , reflux , demography , disease , sociology
Background and Aim Pneumatic dilation (PD) is the most popular nonsurgical treatment for achalasia. This study investigated predicting factors, including manometric subtypes for symptom recurrence in the long term, in patients with achalasia treated with a single PD. Methods Between 1983 and 2013, a total of 107 patients were treated initially with a single PD and included in this longitudinal cohort study. Outcomes were correlated with demographics, symptoms (Eckardt score), and esophagographic and manometric features. Manometric tracings were retrospectively classified according to the three subtypes of the Chicago classification. Results Ninety‐one (85%) patients were successfully treated after the first PD. The median follow‐up was 13.8 years (interquartile range 7–20). During follow‐up, 54% of the patients experienced a clinical relapse. The overall cumulative success rates at 2, 5, 10, 15, 20, and 25 years were 64%, 53%, 49%, 42%, 36%, and 36%, respectively. Age < 40 years, lower esophageal sphincter pressure > 15 mmHg, a cardia width < 5 mm, and an esophageal barium column height > 1 cm 4 to 12 weeks post‐dilation significantly correlated with symptom recurrence, whereas achalasia subtypes did not significantly correlate with the treatment results. Conclusion Pneumatic dilation in achalasia is an effective therapy in the short term, but its effect wanes in the very long term. Young age at presentation, a high lower esophageal sphincter pressure, a narrow cardia, and an esophageal barium column of > 1 cm after PD are predictive factors for the need of repeated treatment.