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Title: Short and Medium-Term Therapeutic Effects of Pneumatic Dilation for Achalasia: a 15-year Tertiary Centre Experience
Authors: Vladimir Andreevski 
Borko Nojkov
Mirko Krstevski
Genadieva Dimitrova, Magdalena 
Nenad Jokismovik
Vladmimir Serafimoski
Keywords: achalasia,
pneumatic dilation,
short and medium-term therapeutic effects
Issue Date: 2013
Publisher: Macedonian Academy of Sciences and Arts
Journal: Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) 
Abstract: Pneumatic dilatation (PD) is commonly used endoscopic technique to weaken the lower esophageal sphincter in patients with achalasia. It is considered as the most effective non-surgical therapeutic option for achalasia, but further data on the overall effectiveness and rate of complications is needed. Aims: Determine the short and medium-term therapeutic effectiveness of PD for achalasia and estimate the cumulative probability of remaining in remission over one year after a single treatment. Study also aimed to identify clinical predictors of therapeutic outcome achieved by PD and assess for PD-related complications. Methods: A total of 26 patients with achalasia who were treated with PD between 1997 and 2011 at a tertiary care center were followed for up to 1 year. Data related to demographics, clinical symptoms and PD-related complications was collected. Short (1 and 3 months) and medium (1 year) term therapeutic effectiveness of PD was assessed with the use of Eckhart scoring system for evaluation of clinical symptoms. Probability of staying in remission one year after a single PD was determined by using Kaplan-Meier estimator. In order to prevent major complications limited maximal pressure of no more than 11 PSI was used during PD. Results: Twenty six patients with symptomatic achalasia (mean age 47.1 ± 18.5 years, 82% males) underwent 44 PD procedures (mean 1.7/patient). Thirteen patients (50%) had a single PD, 10 patients (38%) had two dilatations, and 3 patients (12%) had three or more dilatations over one year. Nineteen out of the 26 patients (73%) were in remission, at one and three months each, following the initial PD. Seventeen out of the 26 patients (65%) remained in remission after one year. A total of 5 patients (19%) were referred for surgery over 1 year due to lack of success of endoscopic treatment. The mean Eckhart symptom scores, at 1 month (3.2 ± 1.2), 3 months (3.5±1.3) and 1 year (1.8 ± 0.6) after the initial PD, were significantly lower when compared to the mean initial Eckhart symptom score (9.7 ± 4.4 ,P<0.05). Using a symptom score above 3 as a cutoff value for treatment failure, the probability of remaining in remission (relapse-free) after a single dilatation was 35% at one year. Patient gender appeared as important treatment outcome predictor. Namely, 4 out of the 5 patients (80%) with PD treatment failure were males. There were no major complications from the 44 PDs. One patient (3.8%) developed significant heartburn. Majority of PDs (33/44, 75%) were followed with minor, subclinical esophageal mucosal bleeding from the dilation site as seen on post-dilation esophagoscopy. Conclusion: Pneumatic dilatation is effective short and medium term treatment option for majority of patients with achalasia without significant related complications. Further studies are warranted to assess the possible role of limited maximal pressure use of no more than 11 PSI during PD in preventing esophageal perforations.
ISSN: 0351-3254
Appears in Collections:Faculty of Medicine: Journal Articles

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