Long-term efficacy of pneumatic dilation and esophageal stenting for the treatment of achalasia.
OBJECTIVE
To compare the efficacy and safety of pneumatic dilation with stenting for the treatment of achalasia.


METHODS
Achalasia patients treated with pneumatic dilation or stenting were included in this analysis. Clinical symptoms were assessed by the Eckardt score. An esophagram and esophageal manometry were performed at the pretreatment and posttreatment follow-up visits. Data such as patient demographics and complications were collected. A drop in the Eckardt score to ≤3 was defined as treatment success.


RESULTS
There were 151 patients treated with pneumatic dilation (n = 76) or stenting (n = 75). The 1-, 12- and 24-month therapeutic success rates were 100, 92 and 79%, respectively, in the dilation group and 100, 93 and 87%, respectively, in the stenting group. The decrease of Eckardt score in the stenting group was significantly notable (p < 0.05) compared to that of the dilation group at the long-term follow-up visits. The maximum esophageal diameter was comparable at baseline and became statistically significant [25 mm (22-30) vs. 22 mm (19-27), p = 0.004] at posttreatment month 24. The recurrence rate was 21% in the dilation group and 13% in the stenting group. The complications of either treatment were usually mild, transient and statistically insignificant.


CONCLUSIONS
Esophageal stenting had a comparable short-term but better long-term efficacy in comparison with pneumatic dilation.
Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
Lijuan
L
Qian
Bin
B
Wang
Kebei
K
Li
Lianzhen
L
Yu
Jing
J
Ding
Hongjie
H
Zhang
Xiafen
X
Ding
Ruihua
R
Shi
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000009:adverse effects; D002637:Chest Pain / Q000209:etiology; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome