Endoscopy 2019; 51(04): S241
DOI: 10.1055/s-0039-1681895
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Esophagus ePosters
Georg Thieme Verlag KG Stuttgart · New York

ACHALASIA: ENDOSCOPIC DILATATION RESULTS AND PREDICTIVE FACTORS OF FAILURE

Authors

  • A Ouni

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • L Hamzaoui

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • B Hasnaoui

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • A Khsiba

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • M Medhioub

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • M Mahmoudi

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia

  • M Msadak Azouz

    1   Gastroenterology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Achalasia is a primary motor disorder of the esophagus. Its treatment consists of decreasing the pressure at the lower esophageal sphincter (LES). Pneumatic dilatation is an efficient therapeutic method compared to surgery. The aim of our work is to study the results of endoscopic dilatation and to identify the predictive factors of failure.

Methods:

We have performed a retrospective analytical study from 2014 to 2018 including patients treated with pneumatic dilatation for mega-esophageal. Patients who have previously undergone Heller surgery or who received a medical treatment were not included. Treatment failure is defined as the persistence of dysphagia after 3 dilatations or relapse within 2 years. The studied parameters were the epidemiological, clinical, manometric data and the results of dilatation.

Results:

Seventeen patients were enrolled with an average age of 47 years and a sex ratio F/H = 1,4. Patients had mean Eckardt score = 7 and chest pain in 41% of cases. 35% of patients were of type I achalasia, whereas 65% were of type II. Seven patients had a resting pressure of LES> 35mmH and 72% had a residual pressure of LES> 10 mmHg. 16 patients had a first dilatation with a 30 mm balloon. The mean number of dilatations was 2,8 and no serious complications were detected except a case of GERD. 47% of patients did not respond to dilatation. In bivariate analysis, only young age< 40 years and the presence of chest pain were predictive of failure (p = 0.008). However, no factor was found in multivariate analysis.

Conclusions:

In this study, endoscopic dilatation represents an efficient method in the treatment of achalasia with a success rate exceeding 50%. The response could have been better once we have included patients with a satisfactory number of dilatations. As mentioned in the literature, young patients and those with chest pain are advised to have Heller myotomy immediately or POEM.