Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia.

Diego Palladino,Claudia Rossi,Andrea Mardighian,Marilina D’Amora,Gianluca Gatta,Francesco Lassandro,Luca Roberto,Guglielmi Giuseppe,Mariano Scaglione

doi:10.1155/2016/2657876

Abstract

Purpose. Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation) versus surgical (Heller myotomy) treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment. Materials and Methods. 19 patients (10 males and 9 females) were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before and after endoscopic or surgical treatment. Results. The mean variation of oesophageal diameter before and after treatment is −2.1 mm for surgery and 1.74 mm for pneumatic dilation (OR 0.167, CI 95% 0.02–1.419, and P: 0.10). The variations of all variables, with the exception of the oesophageal diameter variation, are strongly related to the treatment performed. Conclusions. The barium X-ray study of the digestive tract, performed before and after different treatment approaches, demonstrates that the surgical treatment has to be considered as the treatment of choice of achalasia, reserving endoscopic treatment to patients with high operative risk and refusing surgery.

Highlights

Achalasia is the most frequent primary motor disorder of the esophagus
Aim of the study is to evaluate the efficacy of the endoscopic versus surgical (Heller myotomy) treatment in patients affected by esophageal achalasia through the analysis of parameters deriving from the barium X-ray examination, performed before and after surgical or endoscopic treatment
From January 2009 to December 2014 all the patients referring to our radiology departments for radiological evaluation of achalasia, based on previous esophageal manometry, and planned for surgical or endoscopic treatment were investigated about their clinical history and eligible patients were considered for enrolment in this study

Summary

Introduction

Achalasia is the most frequent primary motor disorder of the esophagus. It is still a rare disease that may occur in both sexes at any age with a prevalence of less than 1/10,000 and with a new cases’ incidence of 0.6–1/100,000 citizens/year [1]. Dysphagia is the typical symptom, consisting in the difficulty in swallowing food; usually the patients have a very long and often unrelated history [3]. Pain is a less frequent symptom and it is usually observed in the early stages of the disease. Regurgitation is the symptom occurring in later stages, when the esophagus is dilated, and may be misdiagnosed as a gastroesophageal reflux disease, leading to diagnosis delay. In this phase, aspirations of food material may be present leading to “ab ingestis pneumonia” in 12% of cases [1]. The therapeutic approach may be pharmacological, endoscopic, and surgical [5]

Methods

Results

Conclusion