Short-term and long-term results of pneumatic dilation in the treatment of patients with esophageal achalasia: 16 years of experience

Česká verzia

Authors: E. Veseliny ; M. Janičko ; Zakuciová M.; P. Jarčuška
Authors place of work: II. interná klinika LF UPJŠ a UN L. Pasteura Košice
Published in the journal: Gastroent Hepatol 2022; 76(3): 236-243
Category:
doi: https://doi.org/10.48095/ccgh2022236

Summary

Background: Pneumatic dilation (PD) is still a common treatment of oesophageal achalasia. This retrospective analysis informs about 16 years of experience with pneumatic dilation in the treatment of patients with achalasia. Patients and methods: Consecutive patients with achalasia treated with endoscopic balloon dilation therapy were analysed retrospectively. The success of endoscopic pneumatic dilation was defined as no treatment other than pneumatic dilation and the overall clinical Eckardt score ≤ 3 (and at the same time each individual item <2). Results: From January 2004 to December 2019, 140 patients with achalasia consecutively underwent pneumatic dilation (67 males [47.9%], mean age 54.9 ±16.2 years). The median follow-up since the first dilation was 125 months (range 6–263 months). Satisfactory results were observed in 130 patients (92.9%). Out of the remaining ten patients, two (1.4%) had periprocedural oesophageal perforation and in 8 (5.7%) patients the treatment eff ect was insufficient. Out of all patients, 107/ 140 (76.4%) had only one PD, 22/ 140 (15.7%) had two PDs, three PDs were performed in 8/ 140 (5.7%) and four PDs in 3/ 140 (2.1%). Treatment failure was more common in patients who had more pneumatic dilations (1 PD 37.5%, 2 and more PDs 62.5%; P = 0.019). Conclusions: Endoscopic balloon dilation, starting with a 35 mm balloon, is an effective treatment for achalasia in the short and long term, with minimal morbidity. The possible incomplete effect of dilation therapy is more often manifested in an earlier period after the initial dilation therapy.

Keywords:

achalasia – long-term results – complications – pneumatic dilation

Zdroje

Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA 2015; 313(18): 1841–1852. doi: 10.1001/ jama.2015.2996.
Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013; 108(8): 1238–1249. doi: 10.1038/ ajg.2013.196.
Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol 1998; 27(1): 21–35. doi: 10.1097/ 000 04836-199807000-00006.
Mikaeli J, Bishehsari F, Montazeri G et al. Pneumatic balloon dilatation in achalasia: a prospective comparison of safety and efficacy with different balloon diameters. Aliment Pharmacol Ther 2004; 20(4): 431–436. doi: 10.1111/ j.1365-2036.2004.02080.x.
Karamanolis G, Sgouros S, Karatzias G et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005; 100(2): 270–274. doi: 10.1111/ j.1572- 0241.2005.40093.x.
Zerbib F, Thétiot V, Richy F et al. Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol 2006; 101(4): 692–697. doi: 10.1111/ j.1572-0241.2006.00385.x.
West RL, Hirsch DP, Bartelsman JF et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol 2002; 97(6): 1346–1351. doi: 10.1111/ j.1572-0241.2002.05771.x.
Hulselmans M, Vanuytsel T, Degreef T et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol 2010; 8(1): 30–35. doi: 10.1016/ j.cgh.2009.09.020.
Vela MF, Richter JE, Khandwala F et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 2006; 4(5): 580–587. doi: 10.1016/ s1542-3565(05)00 986-9.
Campos GM, Vittinghoff E, Rabl C et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 2009; 249(1): 45–57. doi: 10.1097/ SLA.0b 013e31818e43ab.
Boeckxstaens GE, Annese V, des Varannes SB et al. Pneumatic dilation versus laparoscopic Heller‘s myotomy for idiopathic achalasia. N Engl J Med 2011; 364(19): 1807–1816. doi: 10.1056/ NEJMoa1010502.
Moonen A, Annese V, Belmans A et al. Long- -term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65(5): 732–739. doi: 10.1136/ gutjnl-2015-310602.
Harvey PR, Coupland B, Mytton J et al. Outcomes of pneumatic dilatation and Heller‘s myotomy for achalasia in England between 2005 and 2016. Gut 2019; 68(7): 1146–1151. doi: 10.1136/ gutjnl-2018-316544.
Moonen A, Boeckxstaens G. Current diagnosis and management of achalasia. J Clin Gastroenterol 2014; 48(6): 484–490. doi: 10.1097/ MCG.0000000000000137.
Clayton SB, Castell DO. Multiple good options are available for achalasia management. J Clin Gastroenterol 2015; 49(3): 194–198. doi: 10.1097/ MCG.0000000000000107.
Rosemurgy AS, Morton CA, Rosas M et al. A single institution‘s experience with more than 500 laparoscopic Heller myotomies for achalasia. J Am Coll Surg 2010; 210(5): 637–645. doi: 10.1016/ j.jamcollsurg.2010.01.035.
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103(6): 1732–1738. doi: 10.1016/ 0016-5085(92)91428-7.
Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci 1999; 44(9): 1853–1857. doi: 10.1023/ a:1018898824135.
Kostic S, Kjellin A, Ruth M et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 2007; 31(3): 470–478. doi: 10.1007/ s00268-006-0600-9.
Novais PA, Lemme EM. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther 2010; 32(10): 1257–1265. doi: 10.1111/ j.1365- 2036.2010.04461.x.
Borges AA, Lemme EM, Abrahao LJ Jr et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus 2014; 27(1): 18–23. doi: 10.1111/ dote.12064.
Ihara E, Muta K, Fukaura K et al. Diagnosis and treatment strategy of achalasia subtypes and esophagogastric junction outflow obstruction based on high-resolution manometry. Digestion 2017; 95(1): 29–35. doi: 10.1159/ 000452 354.
Oude Nijhuis RAB, Zaninotto G, Roman S et al. European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United European Gastroenterol J 2020; 8(1): 13–33. doi: 10.1177/ 2050640620903213.
Zaninotto G, Bennett C, Boeckxstaens G et al. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018; 31(9): 1–29. doi: 10.1093/ dote/ doy 071.
Katzka DA, Castell DO. Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia. Aliment Pharmacol Ther 2011; 34(8): 832–839. doi: 10.1111/ j.1365-2036.2011.04816.x.
Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004; 53(5): 629–633. doi: 10.1136/ gut.2003.029 298.
Bravi I, Nicita MT, Duca P et al. A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term. Aliment Pharmacol Ther 2010; 31(6): 658–665. doi: 10.1111/ j.1365- 2036.2009.04217.x.
Farhoomand K, Connor JT, Richter JE et al. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2004; 2(5): 389–394. doi: 10.1016/ s1542-3565(04)00 123-5.
Müller M, Keck C, Eckardt AJ et al. Outcomes of pneumatic dilation in achalasia: extended follow- up of more than 25 years with a focus on manometric subtypes. J Gastroenterol Hepatol 2018; 33(5): 1067–1074. doi: 10.1111/ jgh.14 044.
Javed AT, Batte K, Khalaf M et al. Durability of pneumatic dilation monotherapy in treatment-naive achalasia patients. BMC Gastroenterol 2019; 19(1): 181. doi: 10.1186/ s128 76-019-1104-z.
Eckardt VF, Kanzler G, Westermeier T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow- up study. Gastrointest Endosc 1997; 45(5): 349–353. doi: 10.1016/ s0016-5107(97)70 142-1.
Vanuytsel T, Lerut T, Coosemans W et al. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol 2012; 10(2): 142–149. doi: 10.1016/ j.cgh.2011.10.032.
Kadakia SC, Wong RK. Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am 2001; 11(2): 325–346.
Lynch KL, Pandolfino JE, Howden CW et al. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol 2012; 107(12): 1817–1825. doi: 10.1038/ ajg.2012.332.
Chan KC, Wong SK, Lee DW et al. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years‘ experience. Endoscopy 2004; 36(8): 690–694. doi: 10.1055/ s-2004- 825659.
Ates F, Vaezi MF. The pathogenesis and management of achalasia: current status and future directions. Gut Liver 2015; 9(4): 449–463. doi: 10.5009/ gnl14446.