Digestive Diseases and Sciences

, Volume 58, Issue 3, pp 788–796

Treatment of Achalasia by Injection of Sclerosant Substances: A Long-Term Report

  • Manuel Moretó
  • Enrique Ojembarrena
  • Angel Barturen
  • Ignacio Casado
Original Article

DOI: 10.1007/s10620-012-2476-x

Cite this article as:
Moretó, M., Ojembarrena, E., Barturen, A. et al. Dig Dis Sci (2013) 58: 788. doi:10.1007/s10620-012-2476-x

Abstract

Background

Endoscopic sclerotherapy (EST) with ethanolamine oleate (EO) was proposed as a treatment for achalasia, based on the well-known necrotizing effect against the esophageal muscle layers. The aim of this study is to evaluate long-term efficacy of EST.

Methods

Four consecutive series of patients with achalasia were treated according to different schedules over a period of 20 years, by using EO or polidocanol (PD). The primary outcome was dysphagia relief. Secondary outcomes were lower esophageal sphincter pressure, esophagogram, gastroesophageal reflux and endoscopic ultrasonography (EUS). Patients not responding to EST were treated with 30 mm dilation.

Results

A total of 103 patients completed the treatment. On medium-term evaluation, 75 patients who completed the treatment reached a clinical response labeled as “good,” 23 were assessed as “fair,” and 5 were assessed as failures. EUS has become a very informative tool to guide the treatment. The overall follow-up lasted for 87.9 ± 66.7 months. Twelve patients experienced a late failure. The cumulative expectancy of being free of recurrence was 90 % at 50 months with EO, but it was only 65 % with PD. Those patients who responded to rescue measures remained in good or fair clinical condition during the remaining follow-up. Young age, PD, and the so-called fusiform pattern on esophagogram proved to be significant predictors of poor prognosis.

Conclusion

EST with EO is a promising alternative to classic therapies for achalasia. In contrast, PD-treated patients showed an important trend to fibrosis and clinical recurrence. Dilation seems particularly effective after EST, when this technique has failed.

Keywords

Esophageal achalasia Ethanolamine Polidocanol Sclerotherapy 

Abbreviations

EO

Ethanolamine oleate

ESC

Endoscopic success criteria

EST

Endoscopic sclerotherapy

EUS

Endoscopic ultrasonography

GEJ

Gastro-esophageal junction

GER

Gastroesophageal reflux

LES

Lower esophageal sphincter

OSR

Overall satisfactory result

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Manuel Moretó
    • 1
    • 2
  • Enrique Ojembarrena
    • 1
  • Angel Barturen
    • 1
  • Ignacio Casado
    • 1
  1. 1.Gastroenterology and Hepatology Unit, Hospital de Cruces, Medical SchoolUniversity of the Basque CountryBarakaldoSpain
  2. 2.GetxoSpain

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