Long-term efficacy of modified retrievable stents for treatment of achalasia cardia.

Abstract

To investigate the efficacy, safety and optimal duration of placement of modified retrievable metal stents for treatment of achalasia cardia. Patients were randomly divided into groups A (N=26, modified stents for 3days), B (N=26, modified stents for 2days), C (N=24, balloon dilation), and D (N=25, regular stents for 2days). Clinical symptom scores were recorded at baseline, 6months, and during long-term follow-up. Seventy-seven patients with achalasia underwent stent placement (100% success rate of implantation and extraction, no perforation). No stent migration or drop-off occurred in groups A and B. In group D, stent drop-off and migration was observed in 2 and 1 patients, respectively. Two patients in group C sustained esophageal perforation. Patients in the modified stent (A and B), balloon dilated (C) and regular stents (D) groups experienced significant improvement in dysphagia at 6months, with recurrence in 1.92, 8.33 and 28%, respectively. The clinical symptom score in the modified stent groups was significantly lower than that in the balloon dilated group (P=0.01). During long-term follow-up, the symptom scores in modified stent groups were significantly lower than that in the balloon dilated (P<0.01) and regular stent (P<0.01) groups. Modified retrievable metal stents required an optimal placement duration of 2days were safe with no incidence of migration or drop-off and had a lower recurrence of symptoms.