You are here

  • Home
  • Online First
  • Outcomes of pneumatic dilatation and Heller’s myotomy for achalasia in England between 2005 and 2016

Article Text

Article menu

other Versions

Download PDFPDF
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. 1Department of Gastroenterology, Sandwell and West Birmingham Hospitals, West Bromwich, UK
  2. 2Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  3. 3Department 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

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Patient consent for publication Not required.

    • 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.