Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up

摘要

AIM: To determine the best method out of the three types of interventional procedure for achalasia based on a long-term follow-up. METHODS: The study cohort was comprised of 133 patients of achalasia. Among them, 60 patients were treated under fluoroscopy with pneumatic dilation (group A), 8 patients with permanent uncovered or antireflux covered metal stent dilation (group B), and 65 patients with temporary partially covered metal stent dilation (group C). RESULTS: One hundred and thirty dilations were performed on the 60 patients of group A (mean 2.2 times per case). The mean diameter of the strictured cardia was 3.3+-2.1 mm before dilation and 10.6+-3.8 mm after dilation. The mean dysphagia score was 2.7+-1.4 before dilation and 0.9+-0.3 after dilation. Complications in group A were chest pain (n=30), reflux (n=16), and bleeding (n=6). Thirty-six patients (60 %) in group A exhibited dysphagia relapse during a 12-month follow-up, and 45 patients (90 %) out of 50 exhibited dysphagia relapse during a 36-month follow-up. Five uncovered and 3 antireflux covered expandable metal stents were permanently placed in the 8 patients of group B. The mean diameter of the strictured cardia was 3.4+-1.9 mm before dilation and 19.5+-1.1 mm after dilation. The mean dysphagia score was 2.6+-1.3 before dilation and 0.4+-0.1 after dilation. Complications in group B were chest pain (n=6), reflux (n=5), bleeding (n=3), and hyperplasia of granulation tissue (n=3). Four patients (50 %) in group B exhibited dysphagia relapse during a 12-month follow-up, and 2 case (66.7 %) out of 3 patients exhibited dysphagia relapse during a 36-month follow-up. Sixty-five partially covered expandable metal stents were temporarily placed in the 65 patients of group C and withdrawn after 3-7 days via gastroscopy. The mean diameter of the strictured cardia was 3.3+-2.3 mm before dilation and 18.9+-3.5 mm after dilation. The mean dysphagia score was 2.4+-1.3 before dilation and 0.5+-0.2 after dilation. Complications in group C were chest pain (n=26), reflux (n=13), and bleeding (n=8). 6 patients (9.2 %) out of 65 exhibited dysphagia relapse during a 12-month follow-up, and 8 patients (14.5 %) out of 55 exhibited dysphagia relapse during a 36-month follow-up. All the stents were inserted and withdrawn successfully. The follow-up in groups A-C lasted 12-96 months. CONCLUSION: Temporary partially covered metal stent dilation is one of the best methods with interventional procedure for achalasia in terms of long-term follow-up.