Esophageal stasis in achalasia patients without symptoms after treatment does not predict symptom recurrence.
BACKGROUND
After achalasia treatment, a subset of patients has poor esophageal emptying without having symptoms. There is no consensus on whether to pre-emptively treat these patients. We hypothesized that, if left untreated, these patients will experience earlier symptom recurrence than patients without stasis.


METHODS
99 treated achalasia patients who were in clinical remission (Eckardt ≤3) at 3 months after treatment were divided into two groups, based on presence or absence of esophageal stasis on a timed barium esophagogram performed after 3 months.


RESULTS
Two years after initial treatment, patients with stasis after treatment still had a wider esophagus (3 cm; IQR: 2.2-3.8) and more stasis (3.5 cm; IQR: 1.9-5.6) than patients without stasis (1.8 cm wide and 0 cm stasis; both P<.001). In patients with stasis, the esophageal diameter had increased from 2.5 to 3.0 cm within 2 years of follow-up. The symptoms, need for and time to retreatment were comparable between the two groups. Quality of life and reflux symptoms were also comparable between the two groups.


CONCLUSIONS
Although patients with stasis initially had a wider esophagus and 2 years after treatment also had a higher degree of stasis and a more dilated esophagus, compared to patients without stasis, they did not have a higher chance of requiring retreatment. We conclude that stasis in symptom-free achalasia patients after treatment does not predict treatment failure within 2 years and can therefore not serve as a sole reason for retreatment.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
F B
http://orcid.org/0000-0001-6377-3869
FB
van Hoeij
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
A J P M
AJPM
Smout
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
A J
AJ
Bredenoord
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
Achalasia; esophageal clearance; esophageal dilatation; retreatment; therapy