title: Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center.
abstract: BACKGROUND
  The use of pneumatic dilation (PD) is well established in adults with achalasia; however, it is less commonly used in children.
  
  
  OBJECTIVE
  To evaluate the efficacy of PD in pediatric achalasia and to define predictive factors for its treatment failure.
  
  
  METHODS
  Single-center, prospective cohort study.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Twenty-four patients with achalasia were enrolled from January 2004 to November 2009 and were followed for a median of 6 years.
  
  
  METHODS
  PD was performed with the patients under general anesthesia.
  
  
  METHODS
  Efficacy and safety of PD. Follow-up was performed by using the Eckardt score, barium swallow contrast studies, and esophageal manometry at baseline; 1, 3, and 6 months after dilation; and every year thereafter. A Cox regression model was used to identify independent predictors of failure after the first PD.
  
  
  RESULTS
  The PD success rate was 67%. In 8 patients, the first PD failed, but the parents of one patient refused a second PD and requested surgery. Of the 7 patients who underwent repeated treatment, the second PD failed in 3 (43%). Overall, only 3 of the 24 patients underwent surgery (overall success rate after a maximum of 3 PDs was 87%). Multivariate analysis showed that only older age was independently associated with a higher probability of the procedure success (hazard ratio [HR] 0.66; 95% CI, 0.45-0.97).
  
  
  CONCLUSIONS
  Small sample size, single-center study.
  
  
  CONCLUSIONS
  PD is a safe and effective technique in the management of pediatric achalasia. Young age is an independent negative predictive factor for successful clinical outcome.
authors.affiliation: Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.forename: Denis A
authors.initials: DA
authors.lastname: Cozzi
authors.forename: Simone
authors.initials: S
authors.lastname: Frediani
authors.forename: Adriano
authors.initials: A
authors.lastname: Redler
authors.forename: Saverio
authors.initials: S
authors.lastname: Mallardo
authors.forename: Federica
authors.initials: F
authors.lastname: Ferrari
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002404:Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000009:adverse effects; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005762:Gastroenterology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008365:Manometry; D015999:Multivariate Analysis; D011312:Pressure; D016016:Proportional Hazards Models; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D062606:Tertiary Care Centers; D016896:Treatment Outcome