@article{3033393,
    title = "Graded pneumatic dilation in subtype I and II achalasia: long-term
experience in a single center",
    author = "Torresan, Francesco and Cortellini, Fabio and Azzaroli, Francesco and and Ioannou, Alexandros and Mularoni, Cecilia and Shoshan, Dikla and and Mandolesi, Daniele and De Giorgio, Roberto and Karamanolis, George and and Bazzoli, Franco",
    journal = "ANNALS OF GASTROENTEROLOGY",
    year = "2022",
    volume = "35",
    number = "1",
    pages = "28-33",
    publisher = "HELLENIC SOC GASTROENTEROLOGY",
    issn = "1108-7471",
    doi = "10.20524/aog.2021.0683",
    keywords = "Esophageal achalasia; pneumatic dilation; Heller myotomy; endoscopic
gastrointestinal surgery; high-resolution manometry",
    abstract = "Background The efficacy of pneumatic dilation (PD) in the management of
achalasia has yielded variable results. The availability of
high-resolution manometry led to the identification of 3 clinically
relevant subtypes of achalasia, revealing the poor efficacy of PD in
subtype III. Furthermore, PD showed a lower response rate in patients
with subtype III compared to laparoscopic Heller myotomy and peroral
endoscopic myotomy. This study aimed to investigate the short- and
long-term efficacy, safety profile and side effects of PD with a
“graded approach” in subtypes I and II achalasia.
Methods We enrolled 141 patients (male 67, mean age=66 +/- 16.26 years)
with achalasia (n=27 subtype I, n=74 subtype II and n=40 subtype III)
between January 2010 and July 2020 at St. Orsola University Hospital,
Bologna, Italy. We analyzed the data of patients with subtypes I and II,
who underwent a graded-protocol PD. Short- and long-term clinical
efficacy, complications and gastroesophageal reflux disease (GERD) were
recorded.
Results One month after graded protocol PD, 100% subtype I and 96.2%
subtype II achalasia patients showed clinical remission. The PD
procedure was completed without major complications in all patients. In
the long-term follow up (median time: 56 months), 95.5% subtype I and
90% subtype II achalasia patients had an Eckardt score <= 3. GERD
occurred in 27.7% of all patients.
Conclusion A graded-protocol PD applied in the appropriate achalasia
subtypes was shown to be a safe and highly effective approach, in both
the short- and long-term."
}