Endoscopic Pneumatic Dilation Research Articles

Pneumatic balloon dilatation versus laparoscopic Heller myotomy for achalasia: a failed attempt at meta-analysis.

The advent of peroral endoscopic myotomy (POEM) shed some light on the role of the current standards in the treatment of idiopathic achalasia, namely endoscopic pneumatic dilatation (PD) and laparoscopic Heller myotomy (LHM). We analyzed the quality of the current evidence comparing LHM and PD. A systematic literature search was performed in Pubmed/Medline, Web of Science, Google Scholar and Cochrane for meta-analyses/systematic reviews comparing PD and LHM or open surgery, limited to English language full-text articles. After a detailed review of these meta-analyses, all studies included were analyzed further in depth with respect to treatment protocol, assessment of success, complications and sequelae such as gastroesophageal reflux (GER), as well as follow-up details. Six randomized controlled trials (RCT), 5 with LHM and 1 with open surgery, were found, published in 10 papers. In contrast to a rather homogeneous LHM technique, PD regimens as well as the clinical dysphagia scores were different in every RCT; most RCTs also showed methodological limitations. There were nine meta-analyses which included a variable number of these RCTs or other cohort studies. Meta-analyses between 2009 and 2013 favored surgery, while the 4 most recent ones reached divergent conclusions. The main difference might have been whether repeated dilatation was regarded as part of the PD protocol or as failure. The variability in PD techniques and in definition of clinical success utilized in the achalasia RCTs on PD versus LHM render the conclusions of meta-analyses unreliable. Further randomized studies should be based on uniform criteria; in the meantime, publication of even more meta-analyses should be avoided.

Endoscopic Repair of Large Gastric Perforation Following Pneumatic Dilation of Sleeve Gastrectomy Stenosis.

Sleeve gastrectomy has become the most commonly performed bariatric surgery in the USA (English et al.in Surg Obes Relat Dis. 14(3):259-63, 2018). Despite the rising popularity of this procedure, gastric stenosis is a known complication with an incidence of up to 4% (Rebibo et al. in Obes Surg. 26(5):995-1001, 2016). Endoscopic pneumatic balloon dilation is increasingly utilized to treat this condition and to ameliorate symptoms of nausea, vomiting, reflux, and/or dysphagia (Dhorepatil et al. in BMC Surg. 18(1):52, 2018). Pneumatic balloon dilation does carry a risk of gastric perforation of up to 3% in the limited literature to date (Donatelli et al. in Surg Obes Relat Dis. 13(6):943-50, 2017), historically requiring immediate surgical consultation for repair (Donatelli et al. Surg Obes Relat Dis. 13(6):943-50, 2017). In this case series, two cases of gastric perforation during pneumatic dilation for gastric sleeve stenosis were repaired successfully endoscopically with use of an endoscopic suturing system, resulting in correction of gastric defect and elimination of symptoms.

Peroral Endoscopic Myotomy versus Pneumatic Dilation in Achalasia: Dissecting the Randomized Controlled Trial

Ponds FA, Fockens P, Lei A, et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia.

A437 Endoscopic hydrostatic balloon dilation versus pneumatic dilation for post-sleeve gastrectomy symptomatic gastric stenosis: A multicenter experience

Gastric stenosis (GS) is a potential adverse event after sleeve gastrectomy (SG). Different endoscopic interventions are available with no clear guidelines. Our aim was to compare the treatment efficacy and safety between hydrostatic and pneumatic balloon dilation for post-SG symptomatic GS.

Peroral Endoscopic Myotomy (POEM) vs Pneumatic Dilation

Peroral Endoscopic Myotomy (POEM) vs Pneumatic Dilation

Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia

Case series suggest favorable results of peroral endoscopic myotomy (POEM) for treatment of patients with achalasia. Data comparing POEM with pneumatic dilation, the standard treatment for patients with achalasia, are lacking. To compare the effects of POEM vs pneumatic dilation as initial treatment of treatment-naive patients with achalasia. This randomized multicenter clinical trial was conducted at 6 hospitals in the Netherlands, Germany, Italy, Hong Kong, and the United States. Adult patients with newly diagnosed achalasia and an Eckardt score greater than 3 who had not undergone previous treatment were included. The study was conducted between September 2012 and July 2015, the duration of follow-up was 2 years after the initial treatment, and the final date of follow-up was November 22, 2017. Randomization to receive POEM (n = 67) or pneumatic dilation with a 30-mm and a 35-mm balloon (n = 66), with stratification according to hospital. The primary outcome was treatment success (defined as an Eckardt score ≤3 and the absence of severe complications or re-treatment) at the 2-year follow-up. A total of 14 secondary end points were examined among patients without treatment failure, including integrated relaxation pressure of the lower esophageal sphincter via high-resolution manometry, barium column height on timed barium esophagogram, and presence of reflux esophagitis. Of the 133 randomized patients, 130 (mean age, 48.6 years; 73 [56%] men) underwent treatment (64 in the POEM group and 66 in the pneumatic dilation group) and 126 (95%) completed the study. The primary outcome of treatment success occurred in 58 of 63 patients (92%) in the POEM group vs 34 of 63 (54%) in the pneumatic dilation group, a difference of 38% ([95% CI, 22%-52%]; P < .001). Of the 14 prespecified secondary end points, no significant difference between groups was demonstrated in 10 end points. There was no significant between-group difference in median integrated relaxation pressure (9.9 mm Hg in the POEM group vs 12.6 mm Hg in the pneumatic dilation group; difference, 2.7 mm Hg [95% CI, -2.1 to 7.5]; P = .07) or median barium column height (2.3 cm in the POEM group vs 0 cm in the pneumatic dilation group; difference, 2.3 cm [95% CI, 1.0-3.6]; P = .05). Reflux esophagitis occurred more often in the POEM group than in the pneumatic dilation group (22 of 54 [41%] vs 2 of 29 [7%]; difference, 34% [95% CI, 12%-49%]; P = .002). Two serious adverse events, including 1 perforation, occurred after pneumatic dilation, while no serious adverse events occurred after POEM. Among treatment-naive patients with achalasia, treatment with POEM compared with pneumatic dilation resulted in a significantly higher treatment success rate at 2 years. These findings support consideration of POEM as an initial treatment option for patients with achalasia. Netherlands Trial Register number: NTR3593.

Peroral endoscopic myotomy versus pneumatic dilation - result from a retrospective study with 1-year follow-up.

On the basis of lesser rates of major adverse events and a short-term efficacy as Heller's myotomy, there is a growing enthusiasm in favor of peroral endoscopic myotomy (POEM), whereas study comparing POEM and pneumatic dilatation (PD) is quite rare. The aim of this study was to evaluate the efficacy of POEM and PD in Chinese achalasia patients in a retrospectively designed study. Patients with achalasia, who underwent either PD (n = 26) or POEM (n = 40) were retrospectively recruited from September 2010 through March 2016 at a single tertiary center. During the 1-year follow-up, clinical outcome and functional data of lower esophageal sphincter (LES) were recruited. Clinical symptoms were assessed by use of the Eckardt score. The primary outcome was therapeutic success (Eckardt score ≤ 3). Functional data of LES (4-second integrated relaxation pressure [4s-IRP], LES relax rate, and LESP) at baseline and 1 month after treatment were also evaluated. Data was analyzed by SPSS 13.0 version using a significance level of p < 0.05. The success rates were 24/26 (92.31 %), 25/26 (96.15 %), and 24/26 (92.31 %), respectively, with POEM, as compared with 35/40 (87.50 %), 29/40 (72.50 %), and 23/40 (57.50 %), respectively, with PD, 1 month, 3 months, and 1year after treatment. Statistically significant difference was observed between the 2 therapies (at 3 months, Fisher's exact test, p = 0.01; at 1 year, Fisher's exact test, p < 0.0001). Compared with PD, the Eckardt score was lower with POEM 1 month, 3 months, and 1 year after treatment. More patients in POEM group reported gastroesophageal reflux symptoms (after 3 months 7/26 (26.92 %) vs. 2/40 (5.00 %), Fisher's exact test, p = 0.01; after 1 year 6/26 (19.23 %) vs. 1/35 (2.86 %), Fisher's exact test, p = 0.02). The postoperative 4s-IRP and LESP were both lower with POEM than with PD, respectively. Type I achalasia had a better response with POEM than with PD. In this retrospective analysis with 1-year follow-up, POEM presents with a higher success rate and more reflux symptoms compared with PD. Change on LES function after treatment may explain the outcome in part. Type I achalasia may respond better to therapies compared with type II.

Comparison of clinical efficacy of peroral endoscopic myotomy and pneumatic dilation on treatment of achalasia

Objective To compare the advantage and disadvantage of peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) for the treatment of achalasia of cardia (AC). Methods Patients with confirmed AC undergoing endoscopic therapy in Southwest Hospital, Third Military Medical University between January 2011 and September 2014 were divided into POEM treatment group (n=56) and PD treatment group (n=30), according to the decision of the patients and their families. Postoperative improvement of clinical symptoms, changes in the maximum esophageal diameter, complications, hospital stay, and inpatient expenses were compared between the two groups. Results No significant differences were observed in general preoperative data between the two groups, including gender, age, body mass index (BMI), maximum esophageal diameter, Eckardt score and disease duration (all P>0.05). The Eckardt score showed a significant decrease in 1, 6, and 12 months after operation compared to the pre-operation score in both groups (P 0.05). Six months after operation, the response rate between the two groups was no significantly different[93% (52/56) VS 80% (24/30), χ2=0.115, P=0.076], but the maximum esophageal diameter of the POEM group was smaller than that of the PD group (25.39±7.12 mm VS 32.12±9.99 mm, t=3.612, P=0.001). Twelve months after operation, the Eckardt score of the POEM group was lower than that of the PD group (0.44±0.85 score VS 1.26±1.74 score, t=2.940, P=0.004), and the response rate was higher in the POEM group[93% (52/56) VS 80% (24/30), χ2=0.115, P=0.076]. The incidence of pneumatic complications was 32% (18/56) in the POEM group, but none occurred in the PD group (χ2=12.195, P=0.000). The hospital stay of the POEM group and the PD group was 12.33±4.13 days and 6.50±2.28 days, respectively (W=616, P=0.000). The inpatient expense of the POEM group and the PD group was 8 013.283±4 322.695 yuan, and 1 571.018±1 590.193 yuan, respectively (W=505, P=0.000). Conclusion Both POEM and PD showed good short-term efficacy for AC. POEM is more effective, and its treatment outcome lasts longer, whereas PD has more widely indications because it is easier to operate with less complications, shorter hospital stay, and lower costs.Trail registration Chinese clinical trial registry, ChiCTR-OOC-15005889. Key words: Endoscopic therapy; Peroral endoscopic myotomy; Pneumatic dilation; Achalasia; Eckardt score

Symptomatic Stenosis after Laparoscopic Sleeve Gastrectomy - Incidence and Management in a High-Volume Bariatric Surgery Center.

Background: Owing to the increased use of laparoscopic sleeve gastrectomy (LSG) as a metabolic procedure, a rarely associated complication, the Symptomatic Stenosis (SS) will be more often encounter. The objective of this study is to establish a safe and effective management of SS after LSG. Methods: We have analyzed all the patients with SS after LSG treated in Ponderas Academic Hospital from 2011 to 2018. The information was retrospectively extracted from a prospectively maintained database. Laparoscopy and/or endoscopy were used to treat the organic or functional SS. The procedure's outcomes (effectiveness and complications) were analyzed. Results: Out of the 4304 patients with LSG 47 (1.1%) patients were identified with SS after LSG. The incidence is depending on the LSG technique. Other 4 patients referred to our center have been added. Surgery was the first choice in 9 cases with only 33.3% success rate. For the 46 patients referred to endoscopy there have been 79 pneumatic dilation with an average of 1.7+- 1.1 per patient. We have encountered 1 perforation but any hemorrhage or death. Follow-up rate was 93.5%. Over all, the success rate of endoscopic dilatations was 90.7%. Conclusion: The incidence of SS is low. Endoscopic pneumatic dilation is a safe and effective procedure and should be the front line choice in the management of SS after LSG.

Endoscopic pneumatic dilatation and peroral endoscopic myotomy in dilated megaesophagus

Achalasia is a primary esophageal disorderth variable causes, with an incidence between 0.03 to 1/100,000 people, and prevalence of approximately 10/100,000, with no difference between gender. It is more frequent in South and Central America, where Chagas disease is endemic. There are several methods to treat achalasia including endoscopic and surgical procedures, however, all of these methods are palliative. This article discusses 2 different endoscopic methods to treat advanced megaesophagus in Chagas disease, pneumatic balloon dilatation (PBD), and peroral endoscopic myotomy (POEM). Although varying between studies, PBD has an average symptom relief in 93% of patients in 6 months and 44% in 6 years. Some risk factors for failure of PBD are: younger age, male gender, a wider esophagus, poor emptying on post-treatment barium esophagogram and Eckardt scale < 3 before the treatment. Despite relatively short-term follow-up of an average of 3 years, POEM has excellent results. The clinical success achieved in 98 % with the Eckardt score decreased from 6.9 preoperatively to 0.77. Regarding sigmoid-shaped esophagus, only a few papers have been published on POEM. The largest population was 32 patients with a follow-up of 2 years. There was an efficacy of 96%, with the Eckardt scale decreasing from 7.8 to 1.4. In conclusion, PBD, is still widely used mainly due to its availability, especially in patients with a higher surgical risk and in patients who already had a Heller myotomy who persist or develop dysphagia. POEM has already demonstrated excellent results, but it requires advanced technical skills and Long-term results and randomized clinical trials are needed to validate the use of POEM in routine clinical practice.

Russia’s first POEM in the treatment of achalasia in children

The article describes various methods of treatment of achalasia, for example, endoscopic balloon pneumatic dilation that extends the lower esophageal sphincter, injection of botulinum toxin that decreases cardia tone, minimally invasive endoscopic methods in combination with medicinal therapy, and surgical treatment of patients at the fourth stage of the disease that promotes good or satisfactory clinical results in 98.2% of patients. The present study also introduces an optimal algorithm for the examination of patients with suspected achalasiocardia. X-ray diagnostics and endoscopic examination were used to verify the diagnosis. All these methods ensure timely and correct diagnosis, determining also the stage of the disease development. Stage-wise diagnostics in Russia are mostly based on the classification suggested by B.V. Petrovsky in 1962. This classification is founded upon X-ray examination of the esophagus due to its simplicity and availability. The article also presents a completely novel approach for the treatment of achalasiocardia in Russia, that is, peroral endoscopic myotomy (POEM).This method of endoscopic operation has been used in our clinic since 2014 for adult patients, and in 2016, it has been for the first time in Russia performed on a child. A clinical example of achalasiocardia in a child is presented as well as diagnostic methods, medicinal treatment, and the use of balloon pneumatic dilation resulting in a recurrence that subsequently demanded peroral endoscopic myotomy. This minimally invasive endoscopic operation nowadays is highly effective and prospective for the treatment of achalasiocardia in both adults and children.

Control study of peroral endoscopic myotomy and pneumatic dilation in patients with primary achalasia

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients. Methods A retrospective analysis was applied. From September 2010 to March 2015, patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40). High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group. Before and three months after treatment, Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment). Wilcoxon signed rank test was performed for before and after treatment comparison in the same group. Mann-Whitney U test was used to compare between two groups and Fisher′s exact test was used for rate comparison. Results The successful treatment rates at one and three month after POEM group were 92.3%(24/26) and 96.2%(25/26), respectively.The successful treatment rates at one and three month after PD were 87.5%(35/40) and 75.0%(30/40). At three month after treatment, the successful treatment rate of POEM group was higher than that of PD group (Fisher′s exact test, P=0.02). At three months after treatment, the Eckardt score of POEM group was lower than that of PD group (1.35, 0 to 4.00, vs 2.73, 0 to 6.00; U=-3.921, P<0.01). By the end of three months after treatment, the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26, 26.9% vs 2/40, 5.0%; Fisher′s exact test, P=0.01). The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg, 3.48 to 10.40 mmHg vs 10.11 mmHg, 5.75 to 12.91 mmHg, U=-4.541, P<0.01; 11.61 mmHg, 4.21 to 14.64 mmHg vs 17.85 mmHg, 8.39 to 24.57 mmHg, U=-6.142, P<0.01). The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ. Conclusion During short-term follow-up, the efficacy of POEM was better than that of PD in achalasia patients, however there was a higher incidence of post-operative gastroesophageal reflux after POEM. Key words: Achalasia; High-resolution manometry; Pneumatic dilatation; Peroral endoscopic myotomy

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years.

Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients. We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups. A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up. Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.

Endoscopic treatment of esophageal achalasia.

Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.

Different Endoscopic Treatment Options in the Management of Achalasia

In this article, we showed the optimal examination schedule in patients with suspected achalasia. Thediagnostic algorithm of achalasia included X-ray, multispiral computed tomography (MSCT) of the chest and upper abdomen and endoscopic examination methods. All these methods allowed for establishing the exact diagnosis and precise stage of the disease. Th e most common classifi cation for achalasia staging in the Russian Federation is the classifi cation proposed by Petrovskiy B. V. in 1962 which is based on the interpretation of X-ray imaging results because of their simplicity and availability. In this study we also showed diff erent treatment options such as an endoscopic balloon pneumatic dilation used to relieve the obstruction by mechanical disrupting, botulinum toxin injection directed to reduce pressure of the lower esophageal sphincter, minimally invasive interventions with pharmacological therapy, and surgical treatment for patients with IV stage of the disease that may benefi t in 98,2% of those patients. Additionally we showed clinical results of an absolutely new treatment method of endoscopic managing achalasia in the Russian Federation: oral esophageal myotomy (POEM) used in our clinic since 2014. It is a promising and minimally invasive option for treating achalasia. However, it still requires more data and assessment of clinical effi cacy. Refs 19. Figs 8.

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

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.

Comparison of treatment outcomes of endoscope-guided pneumatic dilation and laparoscopic Heller myotomy

The debate on which is the better choice between laparoscopic Heller myotomy (LHM) and endoscopic pneumatic dilation (PD) for esophageal achalasia has been ongoing for decades. This study aims to compare the results of endoscope-guided PD and LHM in 42 patients with achalasia between May 1996 and August 2011. Twenty-one patients who had received PD and 21 who had received LHM were enrolled. The cumulative remission rate was analyzed using the Kaplan–Meier method with the assessment of symptom scores between grades before and after PD or LHM done at 6 weeks, 6 months, 1 year, and then every year thereafter. Possible confounding factors related to the remissions were analyzed by Cox's proportional hazard model. For PD, the cumulative remission rates were 81.0% (1 year), 76.2% (2), 66.7% (3), 61.9% (4), and 47.6% (5). For LHM, the cumulative remission rates were 90.5% every year from the 1st to the 5th. The LHM patients had significantly better remission rates than the PD patients (p = 0.033, by log-rank test). The LHM group had a longer hospital stay than the PD group [median (interquartile range): 8 (6.5–10) days vs. 3 (2–3) days, p < 0.001) and had more reflux complications (52.4% vs. 19.0%, p = 0.024). No perforation occurred in either group. In conclusion, the 5-year cumulative effectiveness of LHM is better than that of PD despite the association of LHM with more reflux events (52.4%).

Clinical Effect of Endoscopic Pneumatic Dilation for Achalasia.

Although pneumatic dilation is an accepted method for the treatment of achalasia, this therapy has high recurrence and complication rates, and prolonged follow-up studies on the parameters associated with various outcomes are rare. In this prospective 10-year follow-up study, a satisfactory therapeutic effect was achieved without serious complications. We report the therapeutic experience with pneumatic dilation, having aimed to evaluate the long-term clinical safety and efficacy of pneumatic dilation.In total, 35 consecutive patients with idiopathic achalasia who underwent pneumatic dilation were followed up at regular intervals in person or by a phone interview over a 10-year period. The mean duration of the follow-up was 43.03 ± 26.34 months (range 6–120 months). Remission was assessed by the dysphagia classification and symptom scores. Patients’ clinical symptom scores were calculated before and at 6 to 36 months, 37 to 60 months, and >60 months after therapy. The influence of the patients’ age, gender, and disease duration on the therapeutic effect was analyzed.The success rate of the operation was 97.2% (35/36), without massive hemorrhaging, perforation or other serious complications. Dysphagia after the therapy was significantly eased (P < 0.01). In total, 35 patients have been followed up for 6 to 36 months after therapy, 21 cases for 37 to 60 months, and 5 cases for >60 months, and the patients’ symptom scores separately decreased significantly compared with the pretherapy scores (P < 0.01). For these patients, the 6 to 36 months remission rate was 85.7% (30/35), the 37 to 60 months rate was 61.9% (13/21), and the >60 months rate was 40% (2/5). The dilation effect had no relationship to the patient's age, gender, and disease duration (P > 0.05). The patients in 30 cases (85.7%) were successfully treated with a single dilation, in 4 cases (11.4%) with 2 dilations, and in 1 case (2.9%) with 3 dilations.These results suggest that endoscopic pneumatic dilation is an achalasia therapy with a good response; it is a simple and safe procedure with long-term clinical effectiveness. It is a preferred method in the treatment of achalasia.

PTU-307 The hidden endoscopic burden of sleeve gastrectomy and its comparison with roux-en-y gastric bypass

<h3>Introduction</h3> In the UK, 61.9% of adults are obese and associated co-morbidity is estimated to cost the NHS £5 billion annually.¹NICE recommends bariatric surgery as a treatment option for some obese patients.²Complications of bariatric surgery are commonly diagnosed and managed by the use of endoscopic procedures, such as endoscopic stent insertion or pneumatic balloon dilatation. This study aims to assess the burden of bariatric surgery-related endoscopy at our hospital, one of the main centres for bariatric surgery in the West Midlands. This is a parallel and enhanced study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” (RYGB) published in Frontline Gastroenterology in 2013³and now also includes data for sleeve gastrectomy. <h3>Method</h3> The retrospective study included all 211 patients undergoing sleeve gastrectomy over a 34 month period. We also utilised the previously collected data for the RYGB patient cohort which included 553 patients over 29 months. In both cohorts, the minimum follow up was 180 days. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications felt to be surgery related. <h3>Results</h3> 16.6% of the sleeve gastrectomy patients required post-operative gastroscopy, of which 11.4% of procedures were therapeutic. This compares to 20.4% of the RYGB cohort of which 50.4% of procedures were therapeutic (p &lt; 0.001). 1.9% of sleeve gastrectomy patients encountered a post-operative staple-line leak and collectively required 29 procedures including 8 stent insertions. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated a cost of £114,458 in endoscopy tariffs, or £105 per RYGB and £267 per sleeve gastrectomy performed. <h3>Conclusion</h3> Bariatric surgery can have significant complications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> NICE Guidance 2014. Obesity: identification, assessment and management of overweight and obesity in children, young people and adults. CG189. London Department of Health Policy. Reducing obesity and improving diet. 2013. [Online]. Available from: https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet[Accessed 1st July 2014] Steed H, Golar H, Manjunath S. The hidden endoscopic burden of Roux-en-Y gastric bypass surgery. Frontline Gastroenterol. 2013;4:69–72

Comparative Study Between Laparoscopic Heller Myotomy Versus Pneumatic Dilatation for Treatment of Early Achalasia: A Prospective Randomized Study.

Achalasia is an incurable primary motor disorder of the esophagus. The best treatment modality for achalasia is still controversial. This study compared the short- and intermediate-term outcome between endoscopic pneumatic dilatation (EPD) versus laparoscopic esophageal myotomy (LEM) for the management of adult patients with early-stage achalasia. This was a prospective randomized controlled study of adult patients (20-50 years old) who presented with early-stage achalasia (esophageal diameter of <3.5 cm on contrast esophagography). Patients were classified into two groups according to the method of management: Group A patients were treated with LEM, whereas Group B patients were treated with EPD. Follow-up evaluations were conducted at 1 week, 3 months, 6 months, and then 1 year. In total, 50 patients were managed for a manometrically confirmed diagnosis of achalasia. The median age of presentation was 31.5 years, with a male-to-female ratio of 0.4:1. Both groups were comparable regarding patient demographics and preoperative severity of the condition. The rate of symptoms relief was 76% in EPD compared with 96% in LEM (P=.04). There was a significant lowering of lower esophageal sphincter in the LEM group (P=.0001). Perforation of the esophagus occurred in 8% of the patients during EPD, whereas mucosal tears occurred in 4% of the patients during LEM. Reflux symptoms developed in 28% and 16% of the patients in the EPD and LEM groups, respectively. LEM was more effective clinically and manometrically for patients with early-stage achalasia than EPD. There was no significant difference between the two procedures regarding complications.