A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term.
BACKGROUND
Long-term follow-up studies of achalasia after pneumatic dilation, mostly retrospective, have shown variable results.


OBJECTIVE
To examine the outcome of achalasia after pneumatic dilation using a prospective follow-up programme.


METHODS
One or two dilations (first dilation treatment) in 77 patients to achieve stable (>1 year) remission and patients followed up with yearly clinical and manometric assessments. Endoscopy, pH monitoring and barium swallow were also performed.


RESULTS
A total of 69 patients achieved stable remission and were followed up for 5.6 years (3-10.7) [median (IQ range)], whereas six patients underwent cardiomyotomy and two experienced a perforation. Twelve of the 69 patients relapsed after 2.6 years (1.7-5.1): nine of 12 underwent one to two further dilations. Six-year remission rate (by Kaplan-Meyer estimates) was 82% after first dilation treatment and 96% after all dilations. Continuous antisecretory treatment was clinically needed in 16%, oesophagitis present in 7% and reflux pathological in 28% of the patients. Beneficial effects of dilation on oesophageal motility and on diameter of the oesophageal body at barium swallow were maintained during follow-up.


CONCLUSIONS
A management strategy including sessions of pneumatic dilation until stable remission and a standardized follow-up is highly successful in the long term. Gastro-oesophageal reflux is clinically relevant in a minority of patients.
Bravi
I
I
Cattedra di Gastroenterologia, Dipartimento di Scienze Mediche and Istituto di Biometria e Statistica Medica, Università degli Studi and Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy.
Nicita
M T
MT
Duca
P
P
Grigolon
A
A
Cantù
P
P
Caparello
C
C
Penagini
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D018572:Disease-Free Survival; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome