BACKGROUND: Long-term follow-up studies of achalasia after pneumatic dilation, mostly retrospective, have shown variable results. AIM: To examine the outcome of achalasia after pneumatic dilation using a prospective follow-up programme. METHODS: One or two dilations (first dilation treatment) in 77 patients to achieve stable (>1 year) remission and patients followed up with yearly clinical and manometric assessments. Endoscopy, pH monitoring and barium swallow were also performed. RESULTS: A total of 69 patients achieved stable remission and were followed up for 5.6 years (3-10.7) [median (IQ range)], whereas six patients underwent cardiomyotomy and two experienced a perforation. Twelve of the 69 patients relapsed after 2.6 years (1.7-5.1): nine of 12 underwent one to two further dilations. Six-year remission rate (by Kaplan-Meyer estimates) was 82% after first dilation treatment and 96% after all dilations. Continuous antisecretory treatment was clinically needed in 16%, oesophagitis present in 7% and reflux pathological in 28% of the patients. Beneficial effects of dilation on oesophageal motility and on diameter of the oesophageal body at barium swallow were maintained during follow-up. CONCLUSIONS: A management strategy including sessions of pneumatic dilation until stable remission and a standardized follow-up is highly successful in the long term. Gastro-oesophageal reflux is clinically relevant in a minority of patients.
A pneumatic dilation strategy in achalasia : prospective outcome and effects on oesophageal motor function in the long term / I. Bravi, M.T. Nicita, P. Duca, A. Grigolon, P. Cantù, C. Caparello, R. Penagini. - In: ALIMENTARY PHARMACOLOGY & THERAPEUTICS. - ISSN 0269-2813. - 31:6(2010 Mar), pp. 658-665.
|Titolo:||A pneumatic dilation strategy in achalasia : prospective outcome and effects on oesophageal motor function in the long term|
BRAVI, IVANA (Primo)
PENAGINI, ROBERTO (Ultimo)
|Settore Scientifico Disciplinare:||Settore MED/12 - Gastroenterologia|
Settore MED/01 - Statistica Medica
|Data di pubblicazione:||mar-2010|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/j.1365-2036.2009.04217.x|
|Appare nelle tipologie:||01 - Articolo su periodico|