title: Short- and medium-term clinical efficacy of three endoscopic therapies for achalasia: a single-blinded prospective study.
abstract: 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.
authors.affiliation: Servicio de Gastroenterología. Hospital Universitario Virgen Macarena. Sevilla. Spain. acaunedoa@meditex.es
authors.forename: A
authors.initials: A
authors.lastname: Caunedo
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: P
authors.initials: P
authors.lastname: Hergueta
authors.forename: B J
authors.initials: BJ
authors.lastname: Gómez
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Téllez
authors.forename: E
authors.initials: E
authors.lastname: Linares
authors.forename: S
authors.initials: S
authors.lastname: Sánchez-Gey
authors.forename: F J
authors.initials: FJ
authors.lastname: Pellicer
authors.forename: J M
authors.initials: JM
authors.lastname: Herrerías
mesh_terms: 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
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D001905:Botulinum Toxins