Long‐term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18‐year single‐centre experience

Elliott, Tessa; Wu, Peter; Fuentealba, S; Szczesniak, Michal; Carle, David J. De; Cook, Ian J.

doi:10.1111/apt.12331

Cited by 28 publications

(17 citation statements)

References 36 publications

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“…Those that have are small with limited power to accurately describe outcomes. In a tertiary hospital cohort of 300 subjects, with a mean follow-up 9.3 years following a successful dilatation, 19/24 and 50/74 were symptom free following repeat dilatation or no further treatment, respectively 6. Thirteen subjects had undergone an alternative treatment.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Harvey

Coupland

Mytton

et al. 2019

Gut

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IntroductionAchalasia is a disorder characterised by failed relaxation of the lower oesophageal sphincter. The aim of this study was to examine, at a national level, the long-term outcomes of achalasia therapies.MethodsHospital Episode Statistics include diagnostic and procedural data for all English National Health Service–funded hospital admissions. Subjects with a code for achalasia who had their initial treatment between January 2006 and December 2015 were grouped by treatment; pneumatic dilatation (PD) or surgical Heller’s myotomy (HM). Procedural failure was defined as time to a further episode of the same therapy or a change to a different therapy. Up to three PDs were permitted without being considered a therapy failure.Results6938 subjects were included; 3619 (52.2%) were men and median age at diagnosis was 59 (IQR 43–75) years. 4748 (68.4%) initially received PD and 2190 (31.6%) HM. The perforation rate following PD was 1.6%. Mortality at 30 days was 0.0% for HM and 1.9% for PD, and <8% after perforation following PD. Factors associated with increased mortality after PD included age quintile 66–77 (OR 4.55 (95% CI 2.00 to 10.38), p<0.001), >77 (9.78 (4.33 to 22.06), p<0.001); Charlson comorbidity score >4 (2.87 (2.08 to 3.95), p<0.001); previous HM (2.47 (1.33 to 4.62), p<0.001); and repeat PD 1–3 (1.58 (1.15 to 2.16), p=0.005), >3 (1.97 (1.21 to 3.19), p=0.006). Durability of up to 3 PD and HM over 10 years of follow-up was 86.2% and 81.9%, respectively (p<0.001).DiscussionThe efficacy of PD for achalasia appears to be greater than HM over 10 years. There was no mortality associated with HM, but 1.9% of subjects died within 30 days of PD. Mortality was associated with increasing age, comorbidity, previous HM and repeat PD.

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Section: Introductionmentioning

confidence: 99%

Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Harvey

Coupland

Mytton

et al. 2019

Gut

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“…Furthermore, the literature does not help determine the most appropriate timeline to resume oral intake. In the majority of publications, liquid diet was allowed 2 -8 hours after dilation [98,101,103]. We recommend that, in asymptomatic patients in whom there is no suspicion of a full-thickness tear, a soft/normal diet can be initiated on the same day or the day after the procedure.…”

Section: Postoperative Carementioning

confidence: 99%

Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2020

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Main RecommendationsESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2 – 4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset.Strong recommendation, high quality of evidence, level of agreement 100 %.ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM).Strong recommendation, very low quality of evidence, level of agreement 87.5 %.ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus.Strong recommendation, low quality of evidence, level of agreement 78.6 %.ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed.Strong recommendation, very low quality of evidence, level of agreement 100 %.ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9 %.ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial.Strong recommendation, low quality of evidence, level of agreement 100 %.

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“…Surgical LES myotomy and peroral endoscopic myotomy (POEM) are other treatment options with comparable success rates. However, PD is a more time‐tested treatment modality with an excellent success rate . It is also cheaper and is associated with fewer complications .…”

Section: Discussionmentioning

confidence: 99%

Frequency and factors associated with malnutrition among patients with achalasia and effect of pneumatic dilation

2019

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BackgroundAlthough achalasia patients are undernourished, studies are scant. We studied: (i) the frequency of malnutrition among these patients and (ii) the effect of pneumatic dilatation (PD) on malnutrition.MethodsA total of 70 adult achalasia patients and 70 healthy controls were evaluated through dietary recall, anthropometry, and biochemical parameters, and patients were reevaluated 6 months after PD.ResultsPatients had lower intake of calories (median, interquartile range [IQR]: 1835.0 [1682.5–1915.0] vs 2071.5 [1950–2276.2] kcal/day, P < 0.001), protein (40.9 [36.3–42.2] vs 52.9 [45.7–62] g/day, P < 0.001), calcium (310 [192.5–392.4] vs 477.5 [350–560] mg/day, P < 0.001), and iron (6.7 [4.7–8.8] vs 10.1 [7.5–11.50] mg/day, P < 0.001) than controls. Patients had lower body mass index (BMI: 19.6 [16.6–22] vs 22.8 [19.5,29.1], P < 0.001), midarm circumference (MAMC; 20 [17.5–23] vs 24.1 [21.4–28.5], P < 0.001), biceps (BSFT; 3.1 [1.9–3.9] vs 5.5 [3.8–9.2] mm, P < 0.001), triceps’ skin fold thickness (TSFT; 5 [2.4–7] vs 7.8 [5.1–9.4] mm, P < 0.001), serum protein (7.2 ± 0.8 vs 7.6 ± 0.8 g/dL, P = 0.005), and albumin (4.0 [3.5–4.4] vs 4.1 [3.9–4.2] g/dL, P = 0.009). PD increased calories (1803 [950–2400] vs 2050 [1470–2950] kcal/day), protein intake (41.0 [22–70] vs 45.0 [37.5–80.0] gm/day), BMI (19.6 [12.8–30.0] vs 22.2[15.9–30.0] P = 0.001 for all), and MAMC (21 [14.1–32.0] vs 24.2 [15–32.0] cm, P = 0.03). Reduced intake was a determinant of malnutrition.ConclusionsMalnutrition is common in achalasia patients, and PD improved it.

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Long‐term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18‐year single‐centre experience

Abstract: SUMMARY BackgroundRelapse after treatment for idiopathic achalasia is common and long-term outcome data are limited.

Cited by 28 publications

References 36 publications

Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Frequency and factors associated with malnutrition among patients with achalasia and effect of pneumatic dilation

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