Short- and medium-term clinical efficacy of three endoscopic therapies for achalasia: a single-blinded prospective study.
OBJECTIVE
to compare the efficacy of three endoscopic therapies for achalasia and to identify predictors of response.


METHODS
prospective, single-blinded study at short and medium term.


METHODS
22 patients (9M/13 F; mean age: 47.45 +/- 21.01 years) with confirmed clinical and manometric achalasia were randomised in three groups: intrasphincteric injections of botulinum toxin (group 1: 10 patients ), injections of 1% polidocanol (group 2:6 patients), and a combined therapy with both of them (group 3: 6 patients). Clinical response was evaluated by a score (0-5) of tested symptoms (dysphagia, regurgitation and chest pain) at 1 and 24 weeks post-treatment.


RESULTS
at 24 weeks post-treatment group 2 had the best complete response (CR) rate (33.33%), whereas CR in both the botulinum toxin and combined therapy groups was 10 and 0%, respectively. Groups 1 and 2 got an overall improvement in clinical score at 1 (p= 0.02) and 24 weeks (p= 0.04). Five patients (50%) in group 1, two patients (33.33%) in group 2, and three patients (50%) in group 3 needed other therapies (dilation or surgery) because of treatment failure. Separately, neither age nor sex, time from diagnosis or type of therapy could distinguish responders from non-responders in these three groups. However, absence of response within the first week, and an initial clinical score above 7 were predictive factors of poor response at six months.


CONCLUSIONS
short- and medium-term clinical response to these endoscopic therapies was limited. The absence of response at seven days and a severe initial clinical score were predictive factors of poor medium-term response.
Caunedo
A
A
Servicio de Gastroenterología. Hospital Universitario Virgen Macarena. Sevilla. Spain. acaunedoa@meditex.es
Romero
R
R
Hergueta
P
P
Gómez
B J
BJ
Rodríguez-Téllez
M
M
Linares
E
E
Sánchez-Gey
S
S
Pellicer
F J
FJ
Herrerías
J M
JM
D000328:Adult; D001905:Botulinum Toxins / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004724:Endoscopy; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000628:therapy*; D004943:Esophagogastric Junction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy; D013997:Time Factors
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D001905:Botulinum Toxins