title: Fluoroscopically guided balloon dilatation for the treatment of achalasia: long-term outcomes.
abstract: To report the immediate and long-term outcomes following the fluoroscopically guided balloon dilatations performed in our department for the treatment of achalasia. We reviewed retrospectively all patients that underwent a fluoroscopically guided balloon dilatation because of achalasia in our department between April 2007 and September 2010. The follow-up was performed by interviews and/or investigation of the patient's medical and imaging records. The primary endpoints of the study were technical success, clinical success, major complication rates, and repeat dilatation rates because of recurrence of clinical symptomatology. Secondary endpoints were the rate of minor complications and the dilatation-free interval. Various parameters that could affect the clinical outcome were also analyzed. Thirty-nine consecutive patients (20 female) with a mean age 44 ± 17 years underwent 69 dilatations, while 10/39 (25.6%) patients had a history of a previous laparoscopic myotomy. The most common symptom was dysphagia (64/69, 92.7%), while regurgitation and/or retrosternal pain were present in 12/39 (30.7%) and 9/39 (23%) of the cases, respectively. Technical success was achieved in 98.5% (68/69). There were no procedure-related major complications. The mean balloon diameter used was 30 ± 3.9 mm, and the mean period of follow-up was 27.7 ± 16.0 months. Excellent or good initial responses were noted in 54/66 cases (81.8%). A repeated dilatation to deal with recurrence of symptoms was performed in 69.4% of the cases (25/36). In the majority of the cases, two dilatations were needed in order to achieve long-term relief from symptoms. A dilatation-free interval of 4 years was observed in 26.4%. Clinical success was achieved in 30/36 patients (83.3%). Subgroup analysis did not detect significantly different recurrence rates in patients with and without previous laparoscopic myotomy (50% vs. 69% respectively), those of young age (75% < 21 years vs. 68.8% > 21 years), and male gender (71.4% male vs. 55.0% females). The high redilatation rate was attributed to the utilization of smaller balloons by less experienced operators. Fluoroscopically guided balloon dilatation is a safe and effective method for the treatment of achalasia. Young age and prior Heller's laparoscopic myotomy were not associated with increased rates of recurrence rate or clinical failure.
authors.affiliation: Department of Interventional Radiology, Guy's and St. Thomas' Hospital, NHS Foundation Trust, London, UK. stavspiliop@upatras.gr
authors.forename: S
authors.initials: S
authors.lastname: Spiliopoulos
authors.forename: T
authors.initials: T
authors.lastname: Sabharwal
authors.forename: R
authors.initials: R
authors.lastname: Inchingolo
authors.forename: M
authors.initials: M
authors.lastname: Krokidis
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: P
authors.initials: P
authors.lastname: Gkoutzios
authors.forename: N
authors.initials: N
authors.lastname: Karunanithy
authors.forename: M
authors.initials: M
authors.lastname: Hanif
authors.forename: R
authors.initials: R
authors.lastname: Dourado
authors.forename: A
authors.initials: A
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D003680:Deglutition Disorders / Q000209:etiology; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007407:Interviews as Topic; D010535:Laparoscopy / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult