Graded pneumatic dilation in subtype I and II achalasia: long-term experience in a single center

Authors Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Alexandros Ioannou, Cecilia Mularoni, Dikla Shoshan, Daniele Mandolesi, Roberto De Giorgio, George Karamanolis, Franco Bazzoli.

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 longterm 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.


Keywords Esophageal achalasia, pneumatic dilation, Heller myotomy, endoscopic gastrointestinal surgery, high-resolution manometry


Ann Gastroenterol 2022; 35 (1): 28-33

Published
2022-01-10
Section
Original Articles