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Predictors of failure of pneumatic dilatation in Achalasia
Most gastroenterologists prefer pneumatic dilatation (PD) as first-line therapy for Achalasia but the reported success rates of this procedure vary widely. In this large study from The Netherlands, Alderliesten et al reviewed 336 patients who were treated with PD between 1974 and 2006. The median follow-up was 129 months (range 1–378). Relatively few complications related to PD occurred (listed in table 1) and there were no fatalities. 111 patients had symptom recurrence requiring repeated treatment. Symptoms recurred after a mean follow-up of 51 months (range 1–348). The authors found that young age at presentation, a manometric pattern of classic achalasia, high LOS pressure 3 months after PD, and incomplete obliteration of the balloon's waist during PD were the most important predicting factors for the need for repeated treatment during follow-up. Patients who meet one or more of these characteristics may be considered earlier for alternative treatment, such as surgery. See page 10.
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