Paper Information

Journal:   GOVARESH JOURNAL   FALL 2015 , Volume 20 , Number SUPPLEMENT; Page(s) 23 To 24.
 
Paper: 

ASSESSMENT OF PNEUMATIC BALLOON DILATION IN PATIENTS WITH SYMPTOMATIC RELAPSE AFTER FAILED HELLER MYOTOMY: A SINGLE CENTER EXPERIENCE

 
 
Author(s):  MIKAELI JAVAD*, AMANI MOHAMMAD, FAZLOLLAHI NARGES, SHIRANI SHAPOUR, MALEKZADEH REZA
 
* DIGESTIVE DISEASE RESEARCH INSTITUTE,TEHRAN UNIVERSITY OF MEDICAL SCIENCES
 
Abstract: 

Introduction: Although Heller myotomy is one of the most effective treatments for achalasia, it may be associated with early or late symptom relapse in some patients. Therefore, additional treatment is required to achieve better control of symptoms.To evaluate the safety and efficacy of pneumatic balloon dilation (PBD) in cases of symptom relapse following Heller myotomy (HM).
Methods: Thirty-six post-myotomy patients were evaluated from 1993 to 2013. Six patients were excluded from the analysis due to comorbid diseases or epiphrenic diverticula. Thirty patients were treated with PBD. Primary outcome was defined as a decrease in symptom score to 4 or less and a reduction greater than 80% from baseline in the volume of barium in timed barium esophagogram in six weeks. Achalasia symptom score (ASS) was assessed 1.5, 3, 6 and 12 months after treatment and then every six months in all patients and PBD was repeated in case of symptom relapse (ASS>4).
Results: The mean age of patients was 45.5
± 13.9 years (range: 21-73). Primary outcome was observed in 25 patients (83%). The mean ASS of patients dropped from 7.8 before treatment to 1.3 ±2.0 at 1.5months after treatment (P=0.0001).The mean volume and height of barium decreased from 43.1±33.4 and 7.1± 4.7 to 6.0± 17.1 and 1.1± 2.2, respectively (P=0.003, P=0.003). The mean duration of follow up was 11.8 ± 6.3 years. At the end of the study, 21 patients (70%) reported sustained good response. No major complications, such as perforation or gross bleeding, were seen.
Conclusion: PBD is an effective and safe treatment option for achalasia in patients with symptom relapse after Heller myotomy.

 
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