Esophageal achalasia: retrospective analysis of treatment during 2000–2010
Abstract
BACKGROUND
Esophageal achalasia (EA) is a primary esophageal motility disorder of unclear aetiology. Standard treatments of EA are: pneumatic balloon dilation (PBD) of the lower esophageal sphyncter (LES) and surgical cleaving of the muscle by Heller myotomy. Although the treatment effectively cures dysphagia, the symptoms recur in about a half of the patients. Our point of interest was long-term effectiveness of EA treatment at our department.
METHODS
We made a retrospective analysis of EA patients treated at our department of thoracic surgery during the 2000–2010 period.
RESULTS
In 11 years we performed 187 PBD and 22 laparoscopic myotomies (LM) in 148 patients. Three years after the procedure 65 % of patients after PBD and 90 % of patients after LM showed no signs of disease. The risk of recurrence was 3.56-times greater (p = 0.03) after PBD (in comparison to LM), whereas patients older than 50 years bear 0.51-times lower risk (p = 0.02). The most significant complicatios were esophageal perforation in 3 patients (1.6 %) after PBD and gastroesophageal reflux in 3 patients (15 %) after LM.
CONCLUSIONS
PBD is a fast, simple, inexpensive and very efficient method of EA treatment, which can be safely performed in almost every patient. LM is far more expensive and a more complicated method that is more suitable for younger patients, in whom PBD is less effective.
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