Long-term Efficacy of Pneumatic Dilatation in Primary Achalasia

Nam, Sang Min; Kim, Joo Sung; Kim, Sang Gyun; Jung, Hyun Chae; Song, In Sung

Abstract

BACKGROUND/AIMS: Pneumatic dilatation has been accepted as the preferred nonoperative treatment modality for primary achalasia. However, long-term effect of pneumatic dilatation on the primary achalasia has not been documented in Korea. The aim of this study was to evaluate the long- term efficacy of pneumatic dilatation and to obtain prognostic factors in primary achalasia.
METHODS
Sixty four patients were enrolled retrospectively between August 1987 and July 2000. Diagnosis of primary achalasia was made by esophagogastroscopy, esophagography and esophageal manometry. Pneumatic dilatation was performed using 10 psi of 30-40 mm balloon for 1-2 sessions. We evaluated clinical efficacy of pneumatic dilatation by medical record review and phone interview, and analyzed prognostic factors by univariate and multivariate analyses.
RESULTS
The clinical remission rates were 95%, 82%, and 76% at 1, 5, and 10 years, respectively. Univariate analysis showed that pneumatic dilatation was significantly more effective when the lower esophageal sphinter pressure (LESP) was reduced over 13 mmHg after treatment. Multivariate analysis demonstrated that LESP reduction tended to be a prognostic factor of primary achalasia in spite of no statistical significance.
CONCLUSIONS
Pneumatic dilatation could be an effective therapy for primary achalasia. Reduction of LESP as a prognostic factor should be confirmed by a large-scale prospective study.