TY - JOUR
TI - Graded pneumatic dilation in subtype I and II achalasia: long-term
experience in a single center
AU - Torresan, Francesco
AU - Cortellini, Fabio
AU - Azzaroli, Francesco and
AU - Ioannou, Alexandros
AU - Mularoni, Cecilia
AU - Shoshan, Dikla and
AU - Mandolesi, Daniele
AU - De Giorgio, Roberto
AU - Karamanolis, George and
AU - Bazzoli, Franco
JO - ANNALS OF GASTROENTEROLOGY
PY - 2022
VL - 35
TODO - 1
SP - 28-33
PB - HELLENIC SOC GASTROENTEROLOGY
SN - 1108-7471
TODO - 10.20524/aog.2021.0683
TODO - Esophageal achalasia; pneumatic dilation; Heller myotomy; endoscopic
gastrointestinal surgery; high-resolution manometry
TODO - 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.
ER -