title: Outcomes in achalasia from a surgical unit where pneumatic dilatation is first-line therapy.
abstract: The management of achalasia remains controversial, with little consensus on the optimal patient treatment pathway. In our own esophageal unit, we offer pneumatic dilatation as the initial therapy in most patients as first-line therapy. In this study, we aimed to examine the safety and efficacy of our own approach to the management of patients with a diagnosis of achalasia, examining symptomatic outcomes, patient satisfaction, and need for further intervention, as well as examining patient factors associated with treatment failure. Sixty-seven consecutive patients underwent pneumatic dilatation as first-line therapy (53% male, mean age 46 years). All attended regular outpatient follow-up (mean 37, range 3-132 months). Twenty-five percent of patients required a second intervention because of symptom recurrence, at a median period of 4.5 months. Symptomatic outcomes were excellent or good in 80%. Significant predictors of treatment failure and poor symptom score included a younger age at the time of diagnosis and increased esophageal diameter on barium swallow. This study suggests that pneumatic dilatation is a safe and effective approach as first-line therapy in patients with newly diagnosed achalasia.
authors.affiliation: Department of Surgery, St. James's Hospital, Dublin, Ireland.
authors.forename: J M
authors.initials: JM
authors.lastname: Howard
authors.forename: A-M
authors.initials: AM
authors.lastname: Mongan
authors.forename: B J
authors.initials: BJ
authors.lastname: Manning
authors.forename: P
authors.initials: P
authors.lastname: Byrne
authors.forename: P
authors.initials: P
authors.lastname: Lawler
authors.forename: N
authors.initials: N
authors.lastname: Ravi
authors.forename: J V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D018450:Disease Progression; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult