Temporary self-expanding metallic stents for achalasia: a prospective study with a long-term follow-up.
OBJECTIVE
To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia.


METHODS
Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm (n = 30, group A), 25 mm (n = 30, group B) or 30 mm (n = 30, group C). Data on clinical symptoms, complications and treatment outcomes were collected, and follow-up was made at 6 mo and at 1, 3-5, 5-8, 8-10 and > 10 years, postoperatively.


RESULTS
Stent placement was successful in all patients. Although chest pain occurrence was high, stent migration was less in group C than in groups A and B. The clinical remission rate at 5-8, 8-10 and > 10 years in group C was higher than that in the other two groups. The treatment failure rate was lower in group C (13%) than in groups A (53%) and B (27%). SEMSs in group C resulted in reduced dysphagia scores and lowered esophageal sphincter pressures, as well as normal levels of barium height and width during all the follow-up time periods. Conversely, these parameters increased over time in groups A and B. The primary patency in group C was longer than in groups A and B.


CONCLUSIONS
A temporary SEMS with a diameter of 30 mm is associated with a superior long-term clinical efficacy in the treatment of achalasia compared with a SEMS with a diameter of 20 mm or 25 mm.
Department of Clinical Center of Imaging Medicine, The Tenth Affiliated People's Hospital, Tongji University, Shanghai 200072, China.
Ying-Sheng
YS
Cheng
Fang
F
Ma
Yong-Dong
YD
Li
Ni-Wei
NW
Chen
Wei-Xiong
WX
Chen
Jun-Gong
JG
Zhao
Chun-Gen
CG
Wu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003680:Deglutition Disorders / Q000453:epidemiology; D004931:Esophageal Achalasia / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008670:Metals; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
D008670:Metals