Most follow-up studies of achalasia are limited to <5 years.
Dr Sawas and colleagues from Minnesota, USA studied the long-term efficacy of pneumatic dilation, and myotomy in achalasia at least 10 years after treatment.
The researchers performed a retrospective cohort study of achalasia patients with >10 years follow-up after initial myotomy or pneumatic dilation.
Symptom recurrence which required repeat dilation or surgery was compared between pneumatic dilation and myotomy.
The team studied 150 patients of similar characteristics.
The mean duration of follow-up after initial treatment was 18 years.
|10% of patients progressed to end-stage achalasia over 40 years|
|Alimentary Pharmacology & Therapeutics|
The researchers noted that symptoms recurrence rate was 61%, demonstrating a lower need for repeat dilation or surgery with myotomy than pneumatic dilation.
All pneumatic dilation patients underwent myotomy in 4 years.
The research team noted that 40 of 53 myotomy patients had symptom recurrence prompting further treatment.
The researchers found that the mean time to repeat procedure was 7 years.
The myotomy group required fewer dilations and/or surgeries than the pneumatic dilation group.
The team observed that 10% of patients progressed to end-stage achalasia over 40 years.
At last follow-up, 92% of patients had absent or mild dysphagia, 85% of patients had regurgitation less than once per week, and 61% had heartburn episodes <1/week similar for pneumatic dilation and myotomy.
Dr Sawas' team commented, "Although the majority of patients treated for achalasia do well after decades of treatment, most patients may need a series of endoscopic and/or surgical procedures to maintain effective symptom control."