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

To determine the best method out of the three types of interventional procedure for achalasia based on a long-term follow-up.

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).

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 Sixty-five partially covered expandable metal stents were temporarily placed in the 65 patients of group C and withdrawn after 3-7 days via gastroscopy.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 All the stents were inserted and withdrawn successfully.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.

Temporary partially covered metal stent dilation is one of the best methods with interventional procedure for achalasia in terms of long-term follow-up.