Clinical Remission in Endoscope-Guided Pneumatic Dilation for the Treatment of Esophageal Achalasia: 7-Year Follow-up Results of a Prospective Investigation

Chuah, Seng‐Kee; Hu, Tsung–Hui; Wu, Keng‐Liang; Hsu, Ping–I; Tai, Wei‐Chen; Chiu, Yi‐Chun; Lee, Chuan–Mo; Changchien, Chi‐Sin

doi:10.1007/s11605-009-0804-z

Cited by 39 publications

(28 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current study, the balloon used for dilation was only 30 mm. Graded balloon dilation starting with a 3 cm Rigiflex balloon as the initial dilator and progressing to 3.5 and 4 cm balloons in the absence of a response to the previous balloon size seems to be the safest approach for successful PD [10]. A review of 21 studies using Rigiflex balloons demonstrated that the initial success rate depends on balloon size, with larger balloons showing better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of treatment outcomes of endoscope‐guided pneumatic dilation and laparoscopic Heller myotomy

Wang

Tai

Chuah

et al. 2015

The Kaohsiung J of Med Scie

Self Cite

View full text Add to dashboard Cite

The debate on which is the better choice between laparoscopic Heller myotomy (LHM) and endoscopic pneumatic dilation (PD) for esophageal achalasia has been ongoing for decades. This study aims to compare the results of endoscope-guided PD and LHM in 42 patients with achalasia between May 1996 and August 2011. Twenty-one patients who had received PD and 21 who had received LHM were enrolled. The cumulative remission rate was analyzed using the Kaplan-Meier method with the assessment of symptom scores between grades before and after PD or LHM done at 6 weeks, 6 months, 1 year, and then every year thereafter. Possible confounding factors related to the remissions were analyzed by Cox's proportional hazard model. For PD, the cumulative remission rates were 81.0% (1 year), 76.2% (2), 66.7% (3), 61.9% (4), and 47.6% (5). For LHM, the cumulative remission rates were 90.5% every year from the 1(st) to the 5(th). The LHM patients had significantly better remission rates than the PD patients (p = 0.033, by log-rank test). The LHM group had a longer hospital stay than the PD group [median (interquartile range): 8 (6.5-10) days vs. 3 (2-3) days, p < 0.001) and had more reflux complications (52.4% vs. 19.0%, p = 0.024). No perforation occurred in either group. In conclusion, the 5-year cumulative effectiveness of LHM is better than that of PD despite the association of LHM with more reflux events (52.4%).

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of treatment outcomes of endoscope‐guided pneumatic dilation and laparoscopic Heller myotomy

Wang

Tai

Chuah

et al. 2015

The Kaohsiung J of Med Scie

Self Cite

View full text Add to dashboard Cite

show abstract

“…Chuah et al17 showed that older patients (> 45 years) had an overall favorable rate of clinical remission in a prospective 7-year follow-up study of endoscopic pneumatic dilatation. Ghoshal et al18 in their study of therapeutic failure after pneumatic dilatation showed on multivariate analysis that male gender was associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

Pratap¹,

Kalapala²,

Darisetty³

et al. 2011

J Neurogastroenterol Motil

181

125

View full text Add to dashboard Cite

Background/AimsHigh-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings.MethodsThe patients who underwent HRM at the Asian Institute of Gastroenterology, Hyderabad between January 2008 and January 2009 were enrolled. The patients with achalasia were categorized into 3 subtypes: type I - achalasia with minimum esophageal pressurization, type II - achalasia with esophageal compression and type III - achalasia with spasm. The clinical and manometric variables and treatment outcomes were compared.ResultsEighty-nine out of the 900 patients who underwent HRM were diagnosed as achalasia cardia. Fifty-one patients with a minimum follow-up period of 6 months were included. Types I and II achalasia were diagnosed in 24 patients each and 3 patients were diagnosed as type III achalasia. Dysphagia and regurgitation were the main presenting symptoms in patients with types I and II achalasia. Patients with type III achalasia had high basal lower esophageal sphincter pressure and maximal esophageal pressurization when compared to types I and II. Most patients underwent pneumatic dilatation (type I, 22/24; type II, 20/24; type III, 3/3). Patients with type II had the best response to pneumatic dilatation (18/20, 90.0%) compared to types I (14/22, 63.3%) and III (1/3, 33.3%).ConclusionsThe type II achalasia cardia showed the best response to pneumatic dilatation.

show abstract

“…The authors suggested that male patients with achalasia should be treated with 35 mm balloon for even the first session of PD as 30 mm balloon often failed in them and post-PD timed barium esophagogram predicted long-term outcome after PD. A prospective study by Chuah et al23 on 32 patients managed with Rigiflex dilator also concluded that age more than 45 years was the only significant factor predicting favorable outcome.…”

Section: Pneumatic Dilationmentioning

confidence: 96%

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

Ghoshal¹,

Murali²

2011

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Pneumatic dilation (PD) is an effective treatment for achalasia cardia. Outcome of PD, however, varies among different studies. Recently, some groups started considering laparoscopic myotomy to be competitive to PD in treatment of achalasia considering dreaded complication like perforation following the latter therapeutic approach. Therefore, there is need to predict outcome of PD for achalasia, so that appropriate therapy, both for treatment naïve and for treatment failed patients can be chosen. Apart from age and gender, 2 investigations, namely post-PD manometry and timed barium esophagogram are most often used to predict outcome after PD. Even though there are studies available in the literature with regard to these modalities to predict outcome of PD, these are quite few in number, including small number of patients, primarily because of rarity of the disease. In this article, we review the literature predicting outcome of PD for achalasia.

show abstract

Clinical Remission in Endoscope-Guided Pneumatic Dilation for the Treatment of Esophageal Achalasia: 7-Year Follow-up Results of a Prospective Investigation

Abstract: Endoscope-guided PD itself is safe and modestly effective for up to 7 years investigations in current study. Older patients (>45 years) have favorable overall clinical remissions.

Cited by 39 publications

References 29 publications

Comparison of treatment outcomes of endoscope‐guided pneumatic dilation and laparoscopic Heller myotomy

Comparison of treatment outcomes of endoscope‐guided pneumatic dilation and laparoscopic Heller myotomy

Achalasia Cardia Subtyping by High-Resolution Manometry Predicts the Therapeutic Outcome of Pneumatic Balloon Dilatation

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

Contact Info

Product

Resources

About