title: Long-term results of pneumatic dilatation for relapsing symptoms of achalasia after Heller myotomy.
abstract: BACKGROUND
  The aim of this study was to assess the efficacy and safety of pneumatic dilatation (PD) to treat symptom recurrence after Heller myotomy (HM).
  
  
  METHODS
  Consecutive patients receiving PD for relapsing symptoms following prior HM were included in this retrospective single-center study. Eckardt score ≤3 and/or ∆ Eckardt (difference between Eckardt score before and after dilatation) ≥3 defined the success of initial dilatation. Patients who maintained response longer than 2 months after initial dilatation were defined as short-term responders. Relapsers were offered further on-demand dilatation. Remission was defined as an Eckardt score ≤3 at the study endpoint. Kaplan-Meier survival curves were used to determine relapse rates.
  
  
  RESULTS
  Eighteen patients (11 women, seven men) were included from January 2004 to January 2013. Ten patients had type I achalasia, and seven had type III, according to the Chicago classification. Thirty-nine PDs were performed (1.5 [1-2.25] per patient). All patients had short-term responses. The remission rate at the endpoint, after a median follow-up of 33 months, was 78%, but 44% were treated with on-demand PD during the follow-up interval. The proportions of patients without relapse and subsequent PD were 72% at 12 months, 65% at 24 and 36 months, and 49% at 48 months. No factors predictive of long-term response, particularly the type of achalasia, could be identified in this series. There were no perforations.
  
  
  CONCLUSIONS
  In treating symptom recurrence following HM, PD was safe and effective over the long term when combined with subsequent PD.
authors.affiliation: Service des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Rennes, Rennes, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Legros
authors.forename: Alain
authors.initials: A
authors.lastname: Ropert
authors.forename: Charlène
authors.initials: C
authors.lastname: Brochard
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bouguen
authors.forename: Maël
authors.initials: M
authors.lastname: Pagenault
authors.forename: Laurent
authors.initials: L
authors.lastname: Siproudhis
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bretagne
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization; D004106:Dilatation; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Heller myotomy; achalasia; pneumatic dilatation; relapse