Graded pneumatic dilation (PD) is a widely accepted treatment for achalasia.
In this study, doctors from Ohio, USA, assessed the predictors of outcome in a large group of patients with achalasia. The team tested the hypothesis that graded PD may not be appropriate for all patients.
The doctors evaluated 75 patients undergoing PD between 1992 and 2002.
|Of the patients treated with a 3cm balloon, 37% had procedure failure within 3 months.|
|Clinical Gastroenterology and Hepatology|
The team evaluated symptom scores for dysphagia, regurgitation, and chest pain. They also measured the degree of esophageal emptying by timed barium swallow.
They defined procedure failure as the return of symptoms resulting in repeated PD or surgical myotomy.
The doctors found that 3-year success rates for PD using 3cm, 3cm followed by 3.5cm, and 3cm and 3.5cm followed by 4cm Rigiflex balloons were 37%, 76%, and 88%, respectively.
The team determined that patient age and sex were important treatment outcome predictors.
They established that 3cm PD was significantly more likely to fail in younger men than older men (hazard ratio 0.63).
The team found that in 37% of the patients initially treated with a 3cm balloon, PD failed within 3 months. Furthermore, 88% of the patients with early failure were men.
Dr Kaveh Farhoomand and colleagues concluded, "Young men have a greater failure rate with 3cm PD than older men or women in general".
"Graded PD in this group starting initially with the 3cm balloon is more likely to fail".