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Oesophagus
Paper
Predictors for outcome of failure of balloon dilatation in patients with achalasia
  1. J Alderliesten1,
  2. J M Conchillo1,
  3. I Leeuwenburgh1,
  4. E W Steyerberg2,
  5. E J Kuipers1,3
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre Rotterdam, The Netherlands
  2. 2Public Health, Erasmus MC University Medical Centre Rotterdam, The Netherlands
  3. 3Internal Medicine, Erasmus MC University Medical Centre Rotterdam, The Netherlands
  1. Correspondence to Dr J Alderliesten, Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands; jalderliesten{at}asz.nl

Abstract

Background Pneumatic balloon dilatation (PD) is a regular treatment modality for achalasia. The reported success rates of PD vary. Recurrent symptoms often require repeated PD or surgery.

Objective To identify predicting factors for symptom recurrence requiring repeated treatment.

Methods Between 1974 and 2006, 336 patients were treated with PD and included in this longitudinal cohort study. The median follow-up was 129 months (range 1–378). Recurrence of achalasia was defined as symptom recurrence in combination with increased lower oesophageal sphincter (LOS) pressure on manometry, requiring repeated treatment. Patient characteristics, results of timed barium oesophagram and manometry as well as baseline PD characteristics were evaluated as predictors of disease recurrence with Kaplan–Meier curves and Cox regression analysis.

Results 111 patients had symptom recurrence requiring repeated treatment. Symptoms recurred after a mean follow-up of 51 months (range 1–348). High recurrence percentages were found in patients younger than 21 years in whom the 5 and 10-year risks of recurrence were 64% and 72%, respectively. These risks were respectively 28% and 36% in patients with classic achalasia, respectively 48% and 60% in patients without complete obliteration of the balloon's waist during PD and respectively 25% and 33% in patients with a LOS pressure greater than 10 mm Hg at 3 months post-dilatation. These four predictors remained statistically significant in a multivariable Cox analysis.

Conclusion Although PD is an effective primary treatment in patients with primary achalasia, patients are at risk of recurrent disease, with this risk increasing during long-term follow-up. Young age at presentation, classic achalasia, high LOS pressure 3 months after PD and incomplete obliteration of the balloon's waist during PD are 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.

  • achalasia
  • pneumatic balloon dilatation
  • predictor
  • recurrence

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/gut.2010.211409

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    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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