title: Clinical Effect of Endoscopic Pneumatic Dilation for Achalasia.
abstract: Although pneumatic dilation is an accepted method for the treatment of achalasia, this therapy has high recurrence and complication rates, and prolonged follow-up studies on the parameters associated with various outcomes are rare. In this prospective 10-year follow-up study, a satisfactory therapeutic effect was achieved without serious complications. We report the therapeutic experience with pneumatic dilation, having aimed to evaluate the long-term clinical safety and efficacy of pneumatic dilation. In total, 35 consecutive patients with idiopathic achalasia who underwent pneumatic dilation were followed up at regular intervals in person or by a phone interview over a 10-year period. The mean duration of the follow-up was 43.03 ± 26.34 months (range 6-120 months). Remission was assessed by the dysphagia classification and symptom scores. Patients' clinical symptom scores were calculated before and at 6 to 36  months, 37 to 60  months, and >60  months after therapy. The influence of the patients' age, gender, and disease duration on the therapeutic effect was analyzed. The success rate of the operation was 97.2% (35/36), without massive hemorrhaging, perforation or other serious complications. Dysphagia after the therapy was significantly eased (P < 0.01). In total, 35 patients have been followed up for 6 to 36  months after therapy, 21 cases for 37 to 60  months, and 5 cases for >60  months, and the patients' symptom scores separately decreased significantly compared with the pretherapy scores (P < 0.01). For these patients, the 6 to 36  months remission rate was 85.7% (30/35), the 37 to 60  months rate was 61.9% (13/21), and the >60  months rate was 40% (2/5). The dilation effect had no relationship to the patient's age, gender, and disease duration (P > 0.05). The patients in 30 cases (85.7%) were successfully treated with a single dilation, in 4 cases (11.4%) with 2 dilations, and in 1 case (2.9%) with 3 dilations. These results suggest that endoscopic pneumatic dilation is an achalasia therapy with a good response; it is a simple and safe procedure with long-term clinical effectiveness. It is a preferred method in the treatment of achalasia.
authors.affiliation: From the Digestive Department (PC, YC, QD), Oncology Department (YZ), Endoscopy Center (JD, WY), and Radiology Department (XH), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Digestive Department (HS), The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, China; and Digestive Department (HZ), Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Cheng
authors.forename: Hai
authors.initials: H
authors.lastname: Shi
authors.forename: Yanjie
authors.initials: Y
authors.lastname: Zhang
authors.forename: Huabang
authors.initials: H
authors.lastname: Zhou
authors.forename: Jinhua
authors.initials: J
authors.lastname: Dong
authors.forename: Yiting
authors.initials: Y
authors.lastname: Cai
authors.forename: Xing
authors.initials: X
authors.lastname: Hu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dai
authors.forename: Wenyan
authors.initials: W
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D004106:Dilatation / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult