FACTORS INFLUENCING CLINICAL OUTCOME OF PNEUMATIC DILATION IN ACHALASIA – INITIAL RESULTS FROM A TERTIARY CENTRE

Aims:

Achalasia is a rare motility disorder of the esophagus that is amenable to multiple modalities of endoscopic treatment. We report on factors influencing the clinical and manometric outcome of graded pneumatic dilation (PD).

Methods:

This is an analysis of an ongoing prospective study of patients with achalasia treated by graded PD in our centre. All patients were assessed clinically (Eckardt symptom score), by upper GI endoscopy and high resolution manometry using the HRiM system (Sandhill Scientific, Inc.). Pneumatic dilation (PD) was performed with a 30 mm diameter polyethylene balloon with progression in the absence of response. Decrease of the Eckardt score below 4 and an integrated relaxation pressure (IRP) of the lower esophageal sphincter < 21 mmHg after PD were considered as indicators of successful treatment.

Results:

Eleven patients with achalasia (6 females, mean age 57 ± 20.1 years) underwent PD in either one (9.1%), two (45.5%) or three sessions (45.4%). The median initial Eckardt score for the cohort was 6 (4 – 11) while the IRP was 38 mmHg (20 – 45). 10/11 (90.9%) patients had an Eckardt score below 4 after the last PD, with 8/11 (72.7%) showing response after the first dilation. No complications were reported. There was an association between successful treatment and a decrease in Eckardt score (p = 0.009), LES resting pressure after the first dilation (p = 0.018), IRP after the first dilation and IRP at the end of treatment (p = 0.005). Age, number of sessions or initial IRP did not influence treatment outcome (p > 0.05).

Conclusions:

Endoscopic pneumatic dilation results in significant clinical improvement, thus being a reasonable approach for first-line treatment of achalasia. The Eckardt score, LESR and IRP after the first dilation and at the end of treatment were associated with successful treatment, irrespective of age or initial manometric measurements.