Endoscopic injection of ethanolamine as a treatment for achalasia: a first report

The present study aimed to test the hypothesis that endoscopic sclerotherapy may effectively reduce the occurrence of spasm at the level of the gastric cardia, offering an effective treatment for achalasia.

We prospectively treated 33 achalasia patients by repeated injection of ethanolamine oleate at the cardiac level. Twenty patients (series I) were reassessed after six to nine months, with a mean follow-up of 31.5 months (range 13-54 months) after treatment. In an attempt to avoid stricture formation, the last 13 patients (series II) were then treated on the basis of the need to reduce the number of injections per session and avoid new treatment while inflammatory or ulcerative signs, or both, were present. The series II patients were followed up for a mean of 11 months (range 1.7-21.3 months).

Overall, a mean of 3.6 treatments was required, and the result was described as "excellent" or "good" in 31 of the 33 patients after one month. Two patients had a poor response to the treatment, but their condition improved after repeat treatment. After six to nine months, the subjective parameters (dysphagia, regurgitation, bronchopulmonary symptoms) and objective parameters (diameter of the esophagus, scintigraphy, manometry), had improved considerably after the treatment in the series I patients, and this improvement was sustained for more than two years, at least by subjective criteria. Four of the 20 series I patients developed mild or moderate fibrotic strictures, but these were managed successfully by standard 15-20 mm balloon dilation. No additional strictures were recorded in the last thirteen patients treated (series II). None of the patients who were followed up had to undergo surgery due to failure of the treatment.

Endoscopic sclerotherapy appears to be a very promising alternative to the currently available therapeutic tools for achalasia.