An end point for pneumatic dilation of achalasia

Cohen, Norman N.

doi:10.1016/s0016-5107(75)73678-7

Cited by 18 publications

(5 citation statements)

References 2 publications

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“…The choice of the 5‐min time‐point in that study was based on the observation that most healthy individuals have emptied their esophagus by 1 min, and all by 5 min. Complete emptying at 5 min at TBE has been used thus as a criterion for an adequate treatment result in achalasia 2,19 . We were unable to confirm the absolute reliability of that criterion in our study as one of 13 patients with normalized emptying at 5 min failed treatment during follow‐up.…”

Section: Discussionmentioning

confidence: 67%

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Andersson

Lundell

Kostic

et al. 2009

Diseases of the Esophagus

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To choose which treatment would be most effective for the individual patient with newly diagnosed achalasia is difficult for the tending physician. A diagnostic tool that would allow prediction of the symptomatic and functional response after treatment for achalasia is therefore needed. The timed barium esophagogram (TBE) is a method that allows objective assessment of esophageal emptying, but the value of TBE in the clinical management of achalasia remains to be clarified. The aim of this study was first, to assess the ability of TBE to predict symptoms and treatment failure during post-treatment follow-up. Second, to determine whether esophageal emptying as assessed by TBE differs after treatment with pneumatic dilatation or laparoscopic myotomy. Fifty-one patients with newly diagnosed achalasia were prospectively randomized to pneumatic dilatation (n = 26) or laparoscopic myotomy (n = 25). Evaluation with TBE was performed before (n = 46) and after treatment (n = 43). The median interval between treatment and post-treatment TBE was 6 months, and the median follow-up time after the post-treatment TBE was 18 months. Following therapeutic intervention, TBE parameters did not differ significantly between treatment groups. However, significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow up for 'dysphagia for liquids' (P < 0.05, rho = 0.47), 'chest pain' (P < 0.05, rho = 0.42), and the 'Watson dysphagia score' (P < 0.05, rho = 0.46). Patients with less than 50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. In summary, pneumatic balloon dilatation and laparoscopic myotomy similarly affected esophageal function as assessed by TBE-emptying. Lack of improvement in barium-column height post-treatment was associated with an increased risk of treatment failure which should motivate close surveillance in order to detect symptomatic recurrence at an early stage.

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Section: Discussionmentioning

confidence: 67%

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Andersson

Lundell

Kostic

et al. 2009

Diseases of the Esophagus

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“…Good to excellent symptom relief has been reported in 50–90% of cases 13 . In general, subjective improvement is poorly correlated with the degree of objective and physiological improvement 14–17 . By this approach, progress of disease will remain unnoticed and the ultimate goal of therapy will not be achieved 10, 18 .…”

Section: Discussionmentioning

confidence: 99%

“…The other technique that was used for objective evaluation of these patients after pneumatic dilation was barium swallow. The results of initial work were conflicting, because the barium studies were not standardized and patient's improvement were assessed by symptom scores 4, 14, 18, 21 . To solve this problem, de Oliveira et al 9 .…”

Section: Discussionmentioning

confidence: 99%

Lower oesophageal sphincter pressure and timed barium oesophagogram: two objective parameters in the non‐invasive assessment of primary achalasia

Montazeri¹,

Nouri²,

Estakhri³

et al. 2005

Aliment Pharmacol Ther

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SUMMARYBackground: The non-invasive assessment of primary achalasia is not precise. Aim: To compare investigations before and 1 month after balloon dilation in achalasia. Methods: Fifty-two patients with primary achalasia were enrolled. Subjective and objective variables of oesophageal functions were analysed before and 1 month after balloon dilation. Results: The mean predilation symptom score, lower oesophageal sphincter pressure, height and volume of barium at 5 min were 7.7 ± 2.6, 62.0 ± 25.1 mmHg, 9.2 ± 6.1 cm and 53.2 ± 49.8 mL respectively; the mean postdilation values were 3.0 ± 3.0, 34.1 ± 12.5

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“…However, the usefulness of the radiographic evaluation of the pneumatically dilated esophagus in predicting the clinical response of patients with achalasia has not been well-documented [5][6][7][8]. We have analyzed the radiographic appearances in 16 patients immediately following pneumatic dilatation of the esophagus for achalasia.…”

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confidence: 99%

Radiographic evaluation of the achalasic esophagus immediately following pneumatic dilatation

Ott

Gelfand

et al. 1984

Gastrointest Radiol

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Sixteen patients with achalasia of the esophagus were treated by fluoroscopically guided pneumatic dilatation. All patients were examined radiographically immediately following dilatation. The caliber of the esophagogastric region increased from a pretreatment mean of 5.3 mm to 9.6 mm following dilatation. The margins of the dilated area remained smooth in 6 patients (38%) and became irregular in 10 (62%). Initial symptomatic improvement was found in 14 patients (88%) with a mean follow-up of 1.7 months. One (6%) perforation occurred, necessitating surgery. The radiographic appearance of the esophagogastric region following pneumatic dilatation, however, poorly predicted patient response.

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An end point for pneumatic dilation of achalasia

Cited by 18 publications

References 2 publications

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial

Lower oesophageal sphincter pressure and timed barium oesophagogram: two objective parameters in the non‐invasive assessment of primary achalasia

Radiographic evaluation of the achalasic esophagus immediately following pneumatic dilatation

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