Endoscopy 2004; 36(8): 690-694
DOI: 10.1055/s-2004-825659
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Short-Term and Long-Term Results of Endoscopic Balloon Dilation for Achalasia: 12 Years’ Experience

K.  C.  Chan1 , S.  K.  H.  Wong1 , D.  W.  H.  Lee1 , W.  L.  M.  Mui1 , A.  C.  W.  Chan1 , E.  K.  W.  Ng1 , J.  C.  Y.  Wu1 , J.  J.  Y.  Sung1 , S.  C.  S.  Chung1
  • 1 Dept. of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
Further Information

Publication History

Submitted 4 November 2003

Accepted after Revision 2 March 2004

Publication Date:
28 July 2004 (online)

Background and Study Aims: This retrospective study reports 12 years’ experience with pneumatic dilation treatment in patients with achalasia and attempts to define factors capable of predicting failure of endoscopic dilation.
Patients and Methods: Consecutive patients with achalasia who received endoscopic balloon dilation were studied retrospectively. Repeat dilation was carried out if dysphagia persisted or recurred. A structured symptom score questionnaire (the Eckardt score) was conducted by phone with patients who had received dilation and had been followed up for more than 2 years. Failure was defined as the presence of significant dysphagic symptoms after more than two repeat dilations. Data for the first 2 years (short-term) and for the subsequent follow-up (long-term) were analyzed.
Results: From 1989 to 2001, 66 patients underwent endoscopic balloon dilation for achalasia; three perforations (4.5 %) occurred, with no mortalities. Dysphagic symptoms significantly improved 12 weeks after the procedure (P < 0.05). Fourteen patients (20 %) required a second dilation procedure within a median of 7 months (range 1 - 52 months), and 13 of them underwent repeat dilations within the first 2 years. Five patients (7.5 %) required further surgical or endoscopic therapy. Fifty-eight patients received pneumatic dilation for more than 2 years; 32 (55 %) responded to the questionnaire. The mean dysphagia score was 1.7 (SD 1.2), with only five patients (16 %) having significant dysphagic symptoms during a median follow-up period of 55 months (range 26 - 130 months). The cumulative success rates for pneumatic dilation after 5 and 19 years were 74 % and 62 %, respectively. Cox regression analysis identified small balloon size (30 mm) as the only significant factor capable of predicting failure of endoscopic dilation (P = 0.009; relative risk 5.3; 95 % confidence interval, 1.7 to 40.9).
Conclusions: Endoscopic balloon dilation is an effective treatment for achalasia, with minimal morbidity (60 % experience long-term benefit).

S. C. S. Chung, M.D.

Dept. of Surgery

Chinese University of Hong Kong · Prince of Wales Hospital, Shatin, NT · Hong Kong SAR · China

Fax: + 852-2637-7974

Email: sydneychung@cuhk.edu.hk

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