Journal of Gastroenterology and Hepatology, May 2018, Vol.33(5), pp.1067-1074
Byline: Michaela Muller, Christina Keck, Alexander J Eckardt, Sarah Werling, Till Wehrmann, Jochem Konig, Ines Gockel Keywords: achalasia; long-term remission; pneumatic dilation; predictors of recurrence Abstract Background and Aim Pneumatic dilation (PD) is the most popular nonsurgical treatment for achalasia. This study investigated predicting factors, including manometric subtypes for symptom recurrence in the long term, in patients with achalasia treated with a single PD. Methods Between 1983 and 2013, a total of 107 patients were treated initially with a single PD and included in this longitudinal cohort study. Outcomes were correlated with demographics, symptoms (Eckardt score), and esophagographic and manometric features. Manometric tracings were retrospectively classified according to the three subtypes of the Chicago classification. Results Ninety-one (85%) patients were successfully treated after the first PD. The median follow-up was 13.8 years (interquartile range 7-20). During follow-up, 54% of the patients experienced a clinical relapse. The overall cumulative success rates at 2, 5, 10, 15, 20, and 25 years were 64%, 53%, 49%, 42%, 36%, and 36%, respectively. Age 15 mmHg, a cardia width 1 cm 4 to 12 weeks post-dilation significantly correlated with symptom recurrence, whereas achalasia subtypes did not significantly correlate with the treatment results. Conclusion Pneumatic dilation in achalasia is an effective therapy in the short term, but its effect wanes in the very long term. Young age at presentation, a high lower esophageal sphincter pressure, a narrow cardia, and an esophageal barium column of 〉 1 cm after PD are predictive factors for the need of repeated treatment. Article Note: Declaration of conflict of interest: None of the authors have any commercial associations that might be a conflict of interest in relation to this investigation. Author contribution: Muller, M., Keck, C., and Gockel, I. contributed equally to all aspects of the article; Muller, M., Gockel, I., and Eckardt, A. J. drafted the paper; Werling, S. and Keck, C. collected the data; Eckardt, A. J., Konig, J., and Wehrmann, T. analyzed and interpreted the data and revised the paper critically for important intellectual content; Muller, M., Keck, C., and Eckardt, A. J. wrote the paper; and Gockel, I. and Wehrmann, T. critically revised the paper with important conceptual and editorial input. All authors give their final approval for publication. The paper includes data from C. Keck's thesis.
Achalasia ; Long‐Term Remission ; Pneumatic Dilation ; Predictors Of Recurrence