title: For patients with primary achalasia the clinical success of pneumatic balloon dilatation can be predicted from the residual fraction of radionuclide during esophageal transit scintigraphy.
abstract: BACKGROUND
  Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia.
  
  
  METHODS
  Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30)/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed.
  
  
  RESULTS
  Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD.
  
  
  CONCLUSIONS
  Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.
authors.affiliation: Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Ilsan, Korea.
authors.forename: Han Ho
authors.initials: HH
authors.lastname: Jeon
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Youn
authors.forename: Kwangwon
authors.initials: K
authors.lastname: Rhee
authors.forename: Jie-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyojin
authors.initials: H
authors.lastname: Park
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Conklin
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People; D004106:Dilatation; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy / Q000295:instrumentation / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011859:Radiography; D011877:Radionuclide Imaging; D012074:Remission Induction; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome