Treatment of Achalasia of the Cardia With Pneumatic Dilations

Goidsenhoven, Guy E. Van; Vantrappen, Gaston; S, Verbeke; Vandenbroucke, J

doi:10.1016/s0016-5085(19)34865-6

Cited by 45 publications

(5 citation statements)

References 37 publications

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“…21±23 Of our patients, 89.5% had clinical and functional improvement initially, and 74% continued to be in remission during the 12 months of follow-up. These results compare favorably with the approximately 65±90% rate of improvement after one or more sessions of pneumatic dilation, 1,3,4,24 as well as with the 64±95% rate of improvement after myotomy. 3,12,25±29 We found that BoTx injection was eective in the immediate relief of symptoms.…”

Section: Discussionsupporting

confidence: 58%

Long-term follow-up of achalasic patients treated with botulinum toxin

D'Onofrio

Annese

Miletto

et al. 2000

Diseases of the Esophagus

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Botulinum toxin A (BoTx), a potent inhibitor of acetylcholine release from nerve endings both within the myenteric plexus and at the nerve-muscle junction, has been shown to decrease the lower esophageal sphincter (LES) pressure in patients with achalasia. Because of this property, the esophageal injection of BoTx has been suggested as an alternative treatment in achalasia. The objective of this study was to determine the long-term efficacy and safety of intrasphincteric injection of BoTx in a group of achalasic patients. Nineteen patients (mean age 56.1 +/- 19.2 years) were enrolled in the study. All of them were injected endoscopically with 100 U of BoTx by sclerotherapy needle at different sites of the LES. Symptom score (dysphagia, regurgitation and chest pain, each on a 0-3 scale), esophageal manometer and esophageal radionuclide emptying were assessed before the treatment and at 4 weeks, 3 months and 1 year after BoTx injection. In case of failure or relapse (symptom score > 2), the treatment was repeated. All but five patients (74%) were in clinical remission at 1 month. Mean symptom score after 1 month of BoTx decreased from 7.1 +/- 0.9 to 2.2 +/- 2.5 (p < 0.05). LES pressure decreased from 38.4 +/- 13.7 to 27.4 +/- 13.5 mmHg (p < 0.05) and 10-min radionuclide retention decreased from 70.9 +/- 20.7% to 33.8 +/- 27.0% (p < 0.05). Side-effects (transient chest pain) were mild and infrequent. At 12 months, the clinical score was 0.9 +/- 0.5 (p < 0.05 vs. basal); mean LES pressure was 22.0 +/- 7.1 (p < 0.05 vs. basal) and 10-min radionuclide retention was 15.8 +/- 6.0% (p < 0.05 vs. basal). The efficacy of the first injection of BoTx lasted for a mean period of 9 months (range 2-14 months). At the time of writing (follow-up period mean 17.6 months, range 2-31), 14 patients (10 with one injection) were still in remission (74%). Our results showed that one or two intrasphincteric injections of BoTx resulted in clinical and objective improvement in about 74% of achalasic patients and are not associated with serious adverse effects; the efficacy of BoTx treatment was long lasting; this procedure could be considered an attractive treatment, especially in elderly patients who are poor candidates for more invasive procedures.

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Section: Discussionsupporting

confidence: 58%

Long-term follow-up of achalasic patients treated with botulinum toxin

D'Onofrio

Annese

Miletto

et al. 2000

Diseases of the Esophagus

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“…The reported incidence of serious complications has ranged from 1 to 16% [10][11][12][13][14]. Although chest pain, fever, and mild gastrointestinal hemorrhage occur occasionally, esophageal perforation is potentially the most serious complication.…”

Section: Discussionmentioning

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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“…Bei der Ballondilatation erfolgt die Dehnung hydrostatisch oder pneumatisch [33,34]. Van Goidsenhoven et al empfahlen 1963 [35] die Methode der "progressiven" pneumatischen Dilatation. Van Goidsenhoven et al empfahlen 1963 [35] die Methode der "progressiven" pneumatischen Dilatation.…”

Section: Dilatationunclassified

Treatment of achalasia

Cosentini

Wenzl

Jakesz

2004

Wien Klin Wochenschr

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Achalasia is a condition of unknown etiology. It represents a motor disorder of the esophagus characterized by absent or incomplete relaxation of the lower esophageal sphincter upon swallowing and by non-propulsive swallow-induced contraction waves or amotility of the esophageal body. Dysphagia and regurgitation of ingesta are the most frequent symptoms. Medical treatment, i.e. by calcium-channel blockers and nitric oxide donors, may be tried in patients with mild dysphagia or in elderly patients but rarely yields adequate symptom relief. Mechanical dilatation of the achalasic sphincter may be performed as an initial treatment option. Intrasphincteric injections of botulinum toxin seemed to be a promising alternative, but it has become obvious that, in most cases, repeated applications of the toxin are required to maintain patients symptom-free. Myotomy of the achalasic sphincter with or without fundoplication to prevent gastroesophageal reflux, is employed mainly in patients in whom dilatations have failed, but since the introduction of minimally invasive surgery, myotomy has become the primary treatment at many centers. This article aims to provide an overview of the development of the conservative and surgical treatment of achalasia.

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Treatment of Achalasia of the Cardia With Pneumatic Dilations

Cited by 45 publications

References 37 publications

Long-term follow-up of achalasic patients treated with botulinum toxin

Long-term follow-up of achalasic patients treated with botulinum toxin

Radiographic evaluation of the achalasic esophagus immediately following pneumatic dilatation

Treatment of achalasia

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