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Oesophagus
Original article
Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016
  1. Philip R Harvey1,2,
  2. Ben Coupland3,
  3. Jemma Mytton3,
  4. Felicity Evison3,
  5. Prashant Patel3,
  6. Nigel J Trudgill1
  1. 1 Department of Gastroenterology, Sandwell and West Birmingham Hospitals, West Bromwich, UK
  2. 2 Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  3. 3 Department of Health Informatics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Nigel J Trudgill, Department of Gastroenterology Sandwell General Hospital Lyndon West Bromwich B71 4HJ, UK; nigel.trudgill{at}nhs.net

Abstract

Introduction Achalasia is a disorder characterised by failed relaxation of the lower oesophageal sphincter. The aim of this study was to examine, at a national level, the long-term outcomes of achalasia therapies.

Methods Hospital Episode Statistics include diagnostic and procedural data for all English National Health Service–funded hospital admissions. Subjects with a code for achalasia who had their initial treatment between January 2006 and December 2015 were grouped by treatment; pneumatic dilatation (PD) or surgical Heller’s myotomy (HM). Procedural failure was defined as time to a further episode of the same therapy or a change to a different therapy. Up to three PDs were permitted without being considered a therapy failure.

Results 6938 subjects were included; 3619 (52.2%) were men and median age at diagnosis was 59 (IQR 43–75) years. 4748 (68.4%) initially received PD and 2190 (31.6%) HM. The perforation rate following PD was 1.6%. Mortality at 30 days was 0.0% for HM and 1.9% for PD, and <8% after perforation following PD. Factors associated with increased mortality after PD included age quintile 66–77 (OR 4.55 (95% CI 2.00 to 10.38), p<0.001), >77 (9.78 (4.33 to 22.06), p<0.001); Charlson comorbidity score >4 (2.87 (2.08 to 3.95), p<0.001); previous HM (2.47 (1.33 to 4.62), p<0.001); and repeat PD 1–3 (1.58 (1.15 to 2.16), p=0.005), >3 (1.97 (1.21 to 3.19), p=0.006). Durability of up to 3 PD and HM over 10 years of follow-up was 86.2% and 81.9%, respectively (p<0.001).

Discussion The efficacy of PD for achalasia appears to be greater than HM over 10 years. There was no mortality associated with HM, but 1.9% of subjects died within 30 days of PD. Mortality was associated with increasing age, comorbidity, previous HM and repeat PD.

  • achalasia
  • endoscopic procedures

https://doi.org/10.1136/gutjnl-2018-316544

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    Footnotes

    • Contributors PRH, PP and NJT conceived of the study. BC, JM and FE extracted the data from HES. All authors contributed to the analysis and drafted the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Not required.

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

    • Data sharing statement HES data are bound by a strict data sharing agreement, which prohibits dissemination of study data to protect patient anonymity. As data are pseudonymised, HES data have been shared by NHS Digital under a data sharing agreement for the purpose of service evaluation.

    • Patient consent for publication Not required.