title: 13-year follow-up of a prospective comparison of the long-term clinical efficacy of temporary self-expanding metallic stents and pneumatic dilatation for the treatment of achalasia in 120 patients.
abstract: OBJECTIVE
  The purpose of this article is to compare the efficacy of self-expanding metallic stents and pneumatic dilation for the long-term clinical treatment of achalasia.
  
  
  METHODS
  Patients diagnosed with achalasia (n = 120) were allocated for treatment with pneumatic dilation (n = 30; group A) or a temporary self-expanding metallic stent with a diameter of 20 mm (n = 30; group B), 25 mm (n = 30; group C), or 30 mm (n = 30; group D). Data on clinical symptoms, complications, and long-term clinical outcomes were collected, and follow-up was performed at 6 months and at 1, 3-5, 5-8, 8-10, and more than 10 years after surgery.
  
  
  RESULTS
  Pneumatic dilation and stent placement were technically successful in all patients. The follow-up at more than 10 years revealed that the clinical remission rate in group D (83.3%) was higher than that in groups A (0%), B (0%), and C (28.6%), and the overall cumulative clinical failure rate in group D (13%) was lower than that in groups A (76.7%), B (53.3%), and C (26.7%). Patients in group D exhibited reduced dysphagia scores and lower esophageal sphincter pressures and had normal levels of barium height and width during the follow-up periods, whereas these markers increased with time in the other groups. The duration of primary patency in group D was also longer than that in groups A, B, and C.
  
  
  CONCLUSIONS
  A temporary self-expanding metallic stent with a diameter of 30 mm has superior clinical efficacy for the treatment of achalasia compared with pneumatic dilation or self-expanding metallic stents with diameters of 20 or 25 mm.
authors.affiliation: Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Yong-Dong
authors.initials: YD
authors.lastname: Li
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Tang
authors.forename: Ying-Sheng
authors.initials: YS
authors.lastname: Cheng
authors.forename: Ni-Wei
authors.initials: NW
authors.lastname: Chen
authors.forename: Wei-Xiong
authors.initials: WX
authors.lastname: Chen
authors.forename: Jun-Gong
authors.initials: JG
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage; D020878:Device Removal; D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008670:Metals; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D008670:Metals; D007472:Iohexol; C038192:iopromide