Esophageal stasis in achalasia patients without symptoms after treatment does not predict symptom recurrence.

Abstract

After achalasia treatment, a subset of patients has poor esophageal emptying without having symptoms. There is no consensus on whether to pre-emptively treat these patients. We hypothesized that, if left untreated, these patients will experience earlier symptom recurrence than patients without stasis. 99 treated achalasia patients who were in clinical remission (Eckardt ≤3) at 3months after treatment were divided into two groups, based on presence or absence of esophageal stasis on a timed barium esophagogram performed after 3months. Two years after initial treatment, patients with stasis after treatment still had a wider esophagus (3cm; IQR: 2.2-3.8) and more stasis (3.5cm; IQR: 1.9-5.6) than patients without stasis (1.8cm wide and 0cm stasis; both P<.001). In patients with stasis, the esophageal diameter had increased from 2.5 to 3.0cm within 2years of follow-up. The symptoms, need for and time to retreatment were comparable between the two groups. Quality of life and reflux symptoms were also comparable between the two groups. Although patients with stasis initially had a wider esophagus and 2years after treatment also had a higher degree of stasis and a more dilated esophagus, compared to patients without stasis, they did not have a higher chance of requiring retreatment. We conclude that stasis in symptom-free achalasia patients after treatment does not predict treatment failure within 2years and can therefore not serve as a sole reason for retreatment.