title: Factors predicting outcome of balloon dilatation in achalasia.
abstract: BACKGROUND
  Balloon dilatation of the lower esophageal sphincter (LES) is one of the effective nonsurgical treatment options in the management of achalasia. We aimed to determine the long-term results of graded balloon dilatation and the factors predicting outcome.
  
  
  METHODS
  Patients followed for more than 12 months between January 1995 to March 2005, without history of endoscopic or surgical therapy before the study, were included (n = 111, mean age 46.3 +/- 16.9 years; follow-up period 46.3 [12-150] months). Patients were evaluated by barium swallow contrast studies, upper endoscopy, and esophageal manometry. Pneumatic dilatation was performed with the use of polyethylene balloon system. Patient outcome was evaluated according to manometric studies and Van Trappen staging as determined following face-to-face interviews with the patients.
  
  
  RESULTS
  We determined clinical response rates of 98%, 85.7%, and 75% at months 24, 48, and 60. According to receiver-operating characteristics (ROC) analysis, age <or=37.5 years, LES pressure (LESP) >or=30.5 mmHg, LESP after first balloon dilatation >or=17.5 mmHg, and balloon number >2 were found to negatively affect treatment response. Young age and higher esophageal body pressure at admission were determined to be negative predictive factors (P = 0.038, relative risk (RR) 2.6, 95% confidence interval [CI] 1.05-6.4 and P = 0.05, RR 1.069, 95% CI 0.99-1.14, respectively).
  
  
  CONCLUSIONS
  Balloon dilatation is an effective treatment of achalasia. Young age, higher esophageal body pressure, and high LESP after first balloon dilatation are negative predictive factors. Patients with young age requiring more than two balloon dilatations are likely to be unresponsive to the treatment.
authors.affiliation: Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. udagli@hotmail.com
authors.forename: Ulkü
authors.initials: U
authors.lastname: Dağli
authors.forename: Sedef
authors.initials: S
authors.lastname: Kuran
authors.forename: Nurten
authors.initials: N
authors.lastname: Savaş
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ozin
authors.forename: Canan
authors.initials: C
authors.lastname: Alkim
authors.forename: Fuat
authors.initials: F
authors.lastname: Atalay
authors.forename: Burhan
authors.initials: B
authors.lastname: Sahin
mesh_terms: D000328:Adult; D002404:Catheterization; D004931:Esophageal Achalasia / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome