Skip to main content

For Patients with Primary Achalasia the Clinical Success of Pneumatic Balloon Dilatation Can Be Predicted from the Residual Fraction of Radionuclide During Esophageal Transit Scintigraphy

Abstract

Background

Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia.

Methods

Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30) and the post-PD rate of reduction of R 30 ((Pre R 30 − Post R 30)/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed.

Results

Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4–8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD.

Conclusion

Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient’s short-term response to EPD.

This is a preview of subscription content, access via your institution.

References

  1. Cohen S. Motor disorders of the esophagus. N Engl J Med. 1979;301:184–192.

    CAS  PubMed  Article  Google Scholar 

  2. Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol. 2005;100:1404–1414.

    PubMed  Article  Google Scholar 

  3. Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol. 1998;27:21–35.

    CAS  PubMed  Article  Google Scholar 

  4. Lopushinsky SR, Urbach DR. Pneumatic dilatation and surgical myotomy for achalasia. JAMA. 2006;296:2227–2233.

    CAS  PubMed  Article  Google Scholar 

  5. Ghoshal UC, Aggarwal R, Kumar S, et al. Pneumatic dilation versus intrasphincteric botulinum toxin injection in the treatment of achalasia cardia in India: an economic analysis. Indian J Gastroenterol. 2002;21:193–196.

    CAS  PubMed  Google Scholar 

  6. Richter JE. Comparison and cost analysis of different treatment strategies in achalasia. Gastrointest Endosc Clin N Am. 2001;11:359–370, viii.

    Google Scholar 

  7. Ghoshal UC, Kumar S, Saraswat VA, et al. Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence. Am J Gastroenterol. 2004;99:2304–2310.

    CAS  PubMed  Article  Google Scholar 

  8. Chawda SJ, Watura R, Adams H, et al. A comparison of barium swallow and erect esophageal transit scintigraphy following balloon dilatation for achalasia. Dis Esophagus. 1998;11:181–187; discussion 187–188.

    Google Scholar 

  9. Ghoshal UC, Rangan M, Misra A. Pneumatic dilation for achalasia cardia: reduction in lower esophageal sphincter pressure in assessing response and factors associated with recurrence during long-term follow up. Dig Endosc. 2012;24:7–15.

    PubMed  Article  Google Scholar 

  10. Alderliesten J, Conchillo JM, Leeuwenburgh I, et al. Predictors for outcome of failure of balloon dilatation in patients with achalasia. Gut. 2011;60:10–16.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. Andersson M, Lundell L, Kostic S, et al. Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial. Dis Esophagus. 2009;22:264–273.

    CAS  PubMed  Article  Google Scholar 

  12. Shen YY, Shiau YC, Sun SS, et al. Using radionuclide esophageal emptying test to evaluate pneumatic dilatation effects for achalasia. Hepatogastroenterology. 2001;48:1061–1063.

    CAS  PubMed  Google Scholar 

  13. Yamashita H, Ashida K, Fukuchi T, et al. Predictive factors associated with the success of pneumatic dilatation in Japanese patients with primary achalasia: a study using high-resolution manometry. Digestion. 2013;87:23–28.

    PubMed  Article  Google Scholar 

  14. Prasek J, Hep A, Dolina J, et al. Dynamic esophageal scintigraphy in patients with achalasia. Nucl Med Rev Cent East Eur. 2000;3:57–60.

    CAS  PubMed  Google Scholar 

  15. Kim CH, Cameron AJ, Hsu JJ, et al. Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc. 1993;68:1067–1073.

    CAS  PubMed  Article  Google Scholar 

  16. Chung JJ, Park HJ, Yu JS, et al. A comparison of esophagography and esophageal transit scintigraphy in the evaluation of usefulness of endoscopic pneumatic dilatation in achalasia. Acta Radiol. 2008;49:498–505.

    PubMed  Article  Google Scholar 

  17. Moon JT, Jung IS, Kim YS, et al. Correlation between Clinical Symptoms and Radiologic Findings before and after Pneumatic Balloon Dilatation for Achalasia. Korean J Gastroenterol. 2008;52:16–20.

    PubMed  Google Scholar 

  18. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut. 2004;53:629–633.

    CAS  PubMed  Article  Google Scholar 

  19. Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–1533.

    PubMed Central  PubMed  Article  Google Scholar 

  20. Stark GA, Castell DO, Richter JE, et al. Prospective randomized comparison of Brown-McHardy and microvasive balloon dilators in treatment of achalasia. Am J Gastroenterol. 1990;85:1322–1326.

    CAS  PubMed  Google Scholar 

  21. Mehta R, John A, Sadasivan S, et al. Factors determining successful outcome following pneumatic balloon dilation in achalasia cardia. Indian J Gastroenterol. 2005;24:243–245.

    PubMed  Google Scholar 

  22. Dagli U, Kuran S, Savas N, et al. Factors predicting outcome of balloon dilatation in achalasia. Dig Dis Sci. 2009;54:1237–1242.

    PubMed  Article  Google Scholar 

  23. Tanaka Y, Iwakiri K, Kawami N, et al. Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia. J Gastroenterol. 2010;45:153–158.

    PubMed  Article  Google Scholar 

  24. Katz PO, Gilbert J, Castell DO. Pneumatic dilatation is effective long-term treatment for achalasia. Dig Dis Sci. 1998;43:1973–1977.

    CAS  PubMed  Article  Google Scholar 

  25. Agha FP, Lee HH. The esophagus after endoscopic pneumatic balloon dilatation for achalasia. AJR Am J Roentgenol. 1986;146:25–29.

    CAS  PubMed  Google Scholar 

  26. Richter JE. Update on the management of achalasia: balloons, surgery and drugs. Expert Rev Gastroenterol Hepatol. 2008;2:435–445.

    PubMed  Article  Google Scholar 

  27. Karamanolis G, Sgouros S, Karatzias G, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol. 2005;100:270–274.

    PubMed  Article  Google Scholar 

  28. West RL, Hirsch DP, Bartelsman JF, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97:1346–1351.

    CAS  PubMed  Article  Google Scholar 

  29. Mariani G, Boni G, Barreca M, et al. Radionuclide gastroesophageal motor studies. J Nucl Med. 2004;45:1004–1028.

    PubMed  Google Scholar 

  30. Pohl D, Tutuian R. Achalasia: an overview of diagnosis and treatment. J Gastrointestin Liver Dis. 2007;16:297–303.

    PubMed  Google Scholar 

  31. de Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol. 1997;169:473–479.

    PubMed  Google Scholar 

  32. Csendes P, Csendes A, Cortes C, et al. Evolutive radiological changes of the esophagus in patients with achalasia who did not receive treatment. Surg Today. 2007;37:183–186.

    PubMed  Article  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hyojin Park.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jeon, H.H., Youn, Y.H., Rhee, K. et al. For Patients with Primary Achalasia the Clinical Success of Pneumatic Balloon Dilatation Can Be Predicted from the Residual Fraction of Radionuclide During Esophageal Transit Scintigraphy. Dig Dis Sci 59, 375–382 (2014). https://doi.org/10.1007/s10620-013-2906-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2906-4

Keywords

  • Achalasia
  • Prognosis
  • Pneumatic dilatation
  • Esophagography
  • Esophageal transit scintigraphy