气囊扩张术治疗贲门失弛缓症的远期预后

Background & Aims:
Achalasia is treated with pneumatic dilation or Heller myotomy, but studies suggest poor long-term outcomes. We analyzed long-term outcomes after initial pneumatic dilation and studied factors associated with failure.

Methods:
A total of 209 patients (111 men; mean age, 51.2±1.4 years) with achalasia who were treated with pneumatic dilation between 1992 and 2002 were followed. Outcomes were correlated with demographics, presenting symptoms, manometric features, and treatment variables by using χ² and Student t tests.

Results:
All patients were initially treated with consecutive esophageal dilations up to balloon diameters of 3.0 (26%), 3.5 (41%), or 4.0cm (33%). After dilations, mean lower esophageal sphincter (LES) pressure had decreased from 31.3±1.3 to 14.0±0.7mmHg (P<.0001); dysphagia decreased from 96% to 26%; and 49% had gained an average of 4.6±0.5kg (weight loss at presentation was 10.6±0.7kg in 39%). During follow-up, 66% required no additional treatment, whereas 23% underwent repeat dilations after 79±8 months. Patients without recurrence were older (41.2±2.1 vs 56.6±1.6 years; P<.0001) and had lower post-treatment LES pressure (17.8±1.2 vs 12.9±0.6mmHg; P<.005). After 70-month follow-up, balloon dilation yielded good or excellent outcomes in 72% of patients. In nonresponders, rescue surgery yielded higher success rates than botulinum toxin therapy (84% vs 44%). Patient satisfaction ranged from good to excellent in 81% of patients.

Conclusions:
Treating achalasia with initial dilation and then surgery for short-term failures yielded good long-term results in more than 70% and treatment satisfaction in more than 80% of patients. Management of dilation failures is more problematic.