Repeated Pneumatic Dilations as Long-Term Maintenance Therapy for Esophageal Achalasia

In esophageal achalasia, pneumatic dilations (PD) provide short-term and long-term remission rates of 60-90% and 40-50%, respectively. The aim of this study was to evaluate the long-term efficacy of repeated PD as long-term maintenance therapy. From 1992 to 2004, 150 patients with esophageal achalas...

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Published in:	The American journal of gastroenterology Vol. 101; no. 4; pp. 692 - 697
Main Authors:	ZERBIB, Frank, THETIOT, Valérie, RICHY, Frédérique, BENAJAH, Dafr-Allah, MESSAGE, Laurent, LAMOULIATTE, Hervé
Format:	Journal Article
Language:	English
Published:	Oxford Blackwell Publishing 01-04-2006 Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subjects:	Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Catheterization - adverse effects Child Esophageal Achalasia - therapy Esophagus Female Follow-Up Studies Gastroenterology Gastroenterology. Liver. Pancreas. Abdomen Humans Male Medical sciences Middle Aged Other diseases. Semiology Recurrence Remission Induction Retreatment Digestive diseases Treatment Esophageal achalasia Long term Esophageal disease Gastroenterology
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Summary:	In esophageal achalasia, pneumatic dilations (PD) provide short-term and long-term remission rates of 60-90% and 40-50%, respectively. The aim of this study was to evaluate the long-term efficacy of repeated PD as long-term maintenance therapy. From 1992 to 2004, 150 patients with esophageal achalasia treated by PD were included in this retrospective study (78 males, mean age 57 +/- 20 yr). PD were performed until remission was achieved (symptom score < or = 3, each item < 2) and subsequently when symptomatic recurrence occurred. A standardized symptoms questionnaire was sent to patients lost to follow-up. Results are expressed as mean +/- SD. Initial remission was achieved in 137 of 150 (91.3%) patients with 2.67 +/- 1.59 dilations [range 1-12]. Failure and perforation rates were 7.3% (n = 11) and 1.3% (n = 2), respectively. After initial remission, 48 of 137 (35%) patients had recurrent symptoms; the probability to be in remission at 5 and 10 yr was 67% and 50%, respectively. At the end of follow-up (45 +/- 38 months, ext. 2-144) 108 of 137 (78.8%) patients were in remission. Among 112 patients whose symptoms could be treated by repeated PD (per protocol analysis), 108 (96.4%) were in remission (3.5 +/- 2.1 PD, ext. 2-12). In this group, the probability of being in remission after repeated PD at 5 and 10 yr was 96.8% and 93.4%, respectively. No pretherapeutic factor influenced long-term remission rate. The overall prevalence of gastroesophageal reflux was 34.7%. One-third of the patients with esophageal achalasia treated by PD will experience symptomatic recurrence during a 4-yr period. Long-term remission can be achieved in virtually all the patients treated by repeated PD according to an "on-demand" strategy based on symptom recurrence.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9270 1572-0241
DOI:	10.1111/j.1572-0241.2006.00385.x