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Long-term prognosis of patients with achalasia treated by cardial dilatation therapy
1Third Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Insights
Expanding bag dilatation therapy for esophageal achalasia shows a 74.2% effectiveness rate, with significant weight gain observed in many patients. Surgery is recommended for cases unresponsive to multiple dilatations.
Area of Science:
- Gastroenterology
- Surgical Innovation
Background:
- Esophageal achalasia is a motility disorder characterized by impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax.
- Expanding bag dilatation therapy offers a minimally invasive approach to managing achalasia.
Purpose of the Study:
- To evaluate the long-term prognosis of expanding bag dilatation therapy for esophageal achalasia.
- To assess the efficacy of this treatment modality based on patient outcomes and weight changes.
Main Methods:
- A retrospective analysis of 163 patients with esophageal achalasia treated with Matsuo pneumatic bag dilator between 1964 and 1989.
- Assessment of therapy efficacy based on body weight changes, overall effectiveness ratings, and need for subsequent surgical intervention.
Main Results:
- Expanding bag dilatation therapy was effective in 74.2% of cases (121/163), with significant body weight increase observed in 65.6% of patients.
- No significant correlation was found between therapy efficacy and pre-therapy dilation grade, prior symptoms, or number of dilatations.
- 16 cases (9.8%) were rated ineffective, with 4.3% requiring subsequent surgery.
Conclusions:
- Expanding bag dilatation therapy provides a favorable long-term prognosis for a majority of esophageal achalasia patients.
- Surgical intervention should be considered for patients who do not achieve satisfactory long-term results after multiple sessions of expanding bag dilatation.
Abstract:
The long-term prognosis of expanding bag dilatation therapy using a Matsuo pneumatic bag dilator was evaluated in 163 cases of esophageal achalasia treated by this method over the 26-year period from 1964 to 1989. In all these cases, one year or more had passed since therapy. Practically no correlation was found between the efficacy of the therapy and the grade of esophageal dilation prior to therapy, the previous history of symptomatic distress or the number of dilatations performed. The efficacy of expanding bag cardial dilatation was most obvious in the increase of body weight, 59 cases (36.2%) showing an increase of 1-5 kg and 48 cases (29.4%) showing an increase of 6-10 kg. The therapy was rated "highly effective" in 61 cases (37.4%) and "effective" in 60 cases (36.8%), i.e. it was effective in a total of 121 cases (74.2%). It was rated as being "ineffective" in 16 cases (9.8%) including 4.3% of cases in which an operation had been performed. This indicated that surgical operation of esophageal achalasia should be performed in those cases in which good long-term results were not obtained even after expanding bag dilatation therapy had been carried out several times.