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Outcome of sequential dilatation in achalasia cardia patients: a prospective cohort study

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Abstract

Background

Sequential increment of balloon diameter for endoscopic pneumatic dilatation is a protocol that is used for symptomatic relief in achalasia cardia. However, most of the studies evaluating its effectiveness are retrospective in nature. This study intended to look into the efficacy of the above protocol in a prospective fashion.

Methods

Consecutive patients of achalasia cardia (n = 72) attending gastroenterology department were subjected to graded dilatation with 30, 35, and 40 mm pneumatic balloon and followed up (median 48 weeks; range: 4–96 weeks) with Eckardt score. Efficacy was assessed by proportion of patients achieving and maintaining clinical remission (Eckardt score ≤ 3) without requiring surgery during follow-up.

Result

Overall 91% of patients (60 out of 66 with follow-up data) remained symptom free without requirement of surgery. Proportion of type 3 achalasia patients was significantly higher in the group requiring surgery compared to those who did not (p = 0.005). Threshold of 12 mm Hg in 4-week post-dilatation integrated relaxation pressure noted to predict future requirement of surgery in type 3 achalasia patients with sensitivity and specificity of 75% and 85%, respectively. Major adverse events requiring in-patient management were 2.9% with perforation noted in 1.9%.

Conclusion

A sequential increment of balloon diameter for pneumatic dilatation in achalasia is an effective mode of therapy to achieve and maintain clinical remission in achalasia. The incidents of adverse events are low in this approach. Type 3 achalasia patients are more likely to require surgery despite sequential dilatation.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, India

    Debashis Misra, Arka Banerjee, Kshaunish Das & Gopal Krishna Dhali

  2. Department of Hepatology, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, India

    Kausik Das

Authors
  1. Debashis Misra
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  2. Arka Banerjee
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  3. Kausik Das
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  4. Kshaunish Das
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  5. Gopal Krishna Dhali
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AB, DM, and KD. The first draft of the manuscript was written by DM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Debashis Misra.

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Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent for it was obtained from all patients for being included in the study.

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All the authors do not have any conflict of interest.

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Misra, D., Banerjee, A., Das, K. et al. Outcome of sequential dilatation in achalasia cardia patients: a prospective cohort study. Esophagus 19, 508–515 (2022). https://doi.org/10.1007/s10388-021-00902-5

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  • DOI: https://doi.org/10.1007/s10388-021-00902-5

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