Esophageal achalasia treatment – factors associated with the outcome of endoscopic balloon dilatation *
Esophageal achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and lower esophageal sphincter (LES) relaxation. Although most patients with esophageal achalasia respond to pneumatic dilation (PD), one-third experience recurrence. Prolonged follow-up studies on parameters associated with positive outcomes after PD are scarce. The aim of this study was to evaluate the short-term efficacy of PD and to investigate the factors associated with the outcome of PD. Between January 2006 and May 2009, 16 patients with esophageal achalasia (5 men, 11 women; mean age 54.8±21.4 years old), diagnosed by clinical symptoms, upper endoscopy, barium esophagogram(EG) and manometry, who received PD were followed-up for a mean period of 15.6 months. Recurrence was defined as the reappearance of either symptoms related to esophageal achalasia or the interruption of barium flow during follow-up tests. Patients were divided into two groups according to their clinical response to PD treatment; the good response group (GR), and the poor response group (PR). Various clinical characteristics, including esophageal manometric parameters, were evaluated between these two groups. Ten out of the 16 patients (62.5%) responded to PD during the mean follow-up period of 15.6 months. Young age, large number of PD procedures and high LES pressure before the PD, or a small change in of LES pressure after PD were associated with a poor outcome. PD is effective in 62.5% of patients with esophageal achalasia. Age, the number of PD, LES pressures before the PD, and a change in of LES pressure after PD were predicting factors to speculate the response of PD. (Accepted on March 27, 2012)
