Abstract
Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up. We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system. Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method. Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.
Highlights
Achalasia is an uncommon motility disorder of the esophagus influencing both sexes with equivalent occurrence and a prevalence of 0.5–1/10 000.1 It is usually diagnosed between the third and sixth decades of life,[1,2] it may occur at any age.Aperistalsis and incomplete lower esophageal sphincter (LES) relaxation are the principal characteristics for achalasia.[3]
Pneumatic balloon dilation (PBD) is recommended as a first line treatment choice to obtain long-term responsiveness.[22]
Some studies found that surgical myotomy had better long-term clinical response than PBD,[23] while others reported similar efficacy or superiority of PBD.[24,25,26]
Summary
Achalasia is an uncommon motility disorder of the esophagus influencing both sexes with equivalent occurrence and a prevalence of 0.5–1/10 000.1 It is usually diagnosed between the third and sixth decades of life,[1,2] it may occur at any age.Aperistalsis and incomplete lower esophageal sphincter (LES) relaxation are the principal characteristics for achalasia.[3]. Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. We report the safety and efficacy of graded gradual PBD on short and long-term follow-up. Methods: We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. Conclusion: Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.
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