Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary esophageal achalasia

Table 1 Clinical characteristics and demographic data of patients [mean ± SD, (min-max)]

Age (yr)	44 ± 16 (19-73)
Gender (M/F)	23/20
Dysphagia	43 (100%)
Chest pain	5 (11%)
Regurgitation	34 (79%)
Pulmonary aspiration	9 (21%)
Mean duration of symptoms (mo)	35 ± 21 (6-72)
Mean weight loss (kg)	7.7 ± 2 (4-11)
LES pressure (mmHg)
Before dilation	38.6 ± 12 (19-66)
After dilation	11.8 ± 8 (0-16)
Vigorous achalasia	1 (2.3%)
Esophagus diameter (cm)	3.8 (2-6.5)

Table 2 Results of rigiflex balloon dilation under endoscopic control

Inflation pressure (psi)	15
Dilation time per session (s)	2 × 60
Success with 3.0 cm balloon	24/42(56%)
Success with 3.5 cm balloon	14/18(78%)
Overall success rate at first year1	19/24(80%)
Overall success rate at 5 years1	7/13(54%)
Complications
Perforation	1(2.3%)
Bleeding	-
Mortality	-

¹Among the patients whose long term follow up information was available.

Table 3 Effect of age, LES pressure and esophageal diameter on the clinical benefit of the initial pneumatic dilation. ¹With 3 cm balloon

	Patients with successful initial pneumatic dilation (n = 24)	Patients with successful initial pneumatic dilation (%)	P
Age (yr)
< 35	4/14	28	< 0.01
35-55	11/17	65
> 55	9/11	82
LES pressure (mmHg)
< 30	6/12	50
30-45	13/21	62	NS
> 45	5/9	55
Esophageal diameter (cm)
< 3	4/7	57
3-4	11/21	52	NS
> 4	9/14	64

NS: Non significant.

Table 4 Cumulative effectiveness of graded pneumatic dilators for achalasia

Author	Pt. #	Study design	Dilator % (size/cm)	Decrease of LESP	% Improvement Excellent/Good	Follow-up (yr) Mean (range)	Perforation (%)
Barkin(11)	50	Prospec.	3.5	-	90	1.3 (1–3.4)	0
Levine(12)	62	Retrosp.	3-3.5	-	85-88	-	0
Wehrmann(15)	40	Retrosp.	3–3.5	42	89	2–5	2.5
Lee(9)	28	Prospec.	3–3.5-4	-	-	-	7
Gelfand(10)	24	Prospec.	3–4	60-68	70–93	-	0
Kadakia(13)	29	Prospec.	3–3.5–4	67	62–79–93	4 (3–6)	0
Abid(14)	36	Retrosp.	3.5–4	-	88–89	2.3 (1–4)	6.6
Lambroza(16)	27	Retrosp.	3	-	67	1.8 (0.1–4.8)	0
Bhatnagar(17)	15	Prospec.	3–3.5	-	73-93	1.2 (0.3–3)	0