Long-term results of pneumatic dilation for achalasia: A15 years' experience  

作　　者：Panagiotis Katsinelos Jannis Kountouras George Paroutoglou Athanasios Beltsis Christos Zavos Basilios Papaziogas Kostas Mimidis 

机构地区：[1]Department of Endoscopy and Motility Unit Central Hospital, Thessaloniki, Greece [2]Department of Medicine Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece

出　　处：《World Journal of Gastroenterology》2005年第36期5701-5705,共5页世界胃肠病学杂志（英文版）

摘　　要：AIM： Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years＇ experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation. METHODS： Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia （diagnosed by clinical presentation, esophagoscopy, barium esophagogram, and manometry） who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS： Symptoms were dysphagia （n = 39, 100%）, regurgitation （n = 23, 58.7%）, chest pain （n = 4, 10.2%）, and weight loss （n = 26, 66.6%）. A total of 74 dilations were performed in 39 patients; 13 patients （28%） underwent a single dilation, 17 patients （48.7%） required a second procedure within a median of 26.7 mo （range 5-97mo）, and 9 patients （23.3%） underwent a third procedure within a median of 47.8 mo （range 37-120 mo）. Post-dilation lower esophageal sphincter （LES） pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4- 10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years （range 0.5-15 years）. The dysphagia- free duration by Kaplan-Neier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION： Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. 2005 The W.IG Press and Elsevier Inc. All rights reserved.AIM: Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years' experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation.METHODS: Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia (diagnosed by clinical presentation, esophagoscopy,barium esophagogram, and manometry) who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score.The median dysphagia-free duration was calculated by Kaplan-Meier analysis.RESULTS: Symptoms were dysphagia (n = 39, 100%),regurgitation (n =23, 58.7%), chest pain (n = 4, 10.2%),and weight loss (n = 26, 66.6%). A total of 74 dilations were performed in 39 patients; 13 patients (28%) underwent a single dilation, 17 patients (48.7%) required a second procedure within a median of 26.7 mo (range 5-97 mo), and 9 patients (23.3%) underwent a third procedure within a median of 47.8 mo (range 37-120 mo). Post-dilation lower esophageal sphincter (LES) pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4-10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years (range 0.5-15 years). The dysphagiafree duration by Kaplan-Meier analysis was 78%, 61%and 58.3% after 5, 10 and 15 years respectively.CONCLUSION: Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response.

关 键 词：Pneumatic dilation Primary achalasia ESOPHAGOSCOPY Barium esophagogram  Manometry 

分 类 号：R571[医药卫生—消化系统]