Graded pneumatic dilation in subtype I and II achalasia: long-term experience in a single center.

Autor:	Torresan F; Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli)., Cortellini F; Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)., Azzaroli F; Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)., Ioannou A; 2 Department of Surgery, Gastroenterology Unit, 'Aretaieio' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Alexandros Ioannou, George Karamanolis)., Mularoni C; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)., Shoshan D; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)., Mandolesi D; Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli)., De Giorgio R; Department of Translational Medicine, University of Ferrara, Ferrara, Italy (Roberto De Giorgio)., Karamanolis G; 2 Department of Surgery, Gastroenterology Unit, 'Aretaieio' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Alexandros Ioannou, George Karamanolis)., Bazzoli F; Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli).
Jazyk:	angličtina
Zdroj:	Annals of gastroenterology [Ann Gastroenterol] 2022 Jan-Feb; Vol. 35 (1), pp. 28-33. Date of Electronic Publication: 2021 Dec 09.
DOI:	10.20524/aog.2021.0683
Abstrakt:	Background: The efficacy of pneumatic dilation (PD) in the management of achalasia has yielded variable results. The availability of high-resolution manometry led to the identification of 3 clinically relevant subtypes of achalasia, revealing the poor efficacy of PD in subtype III. Furthermore, PD showed a lower response rate in patients with subtype III compared to laparoscopic Heller myotomy and peroral endoscopic myotomy. This study aimed to investigate the short- and long-term efficacy, safety profile and side effects of PD with a "graded approach" in subtypes I and II achalasia. Methods: We enrolled 141 patients (male 67, mean age=66±16.26 years) with achalasia (n=27 subtype I, n=74 subtype II and n=40 subtype III) between January 2010 and July 2020 at St. Orsola University Hospital, Bologna, Italy. We analyzed the data of patients with subtypes I and II, who underwent a graded-protocol PD. Short- and long-term clinical efficacy, complications and gastroesophageal reflux disease (GERD) were recorded. Results: One month after graded protocol PD, 100% subtype I and 96.2% subtype II achalasia patients showed clinical remission. The PD procedure was completed without major complications in all patients. In the long-term follow up (median time: 56 months), 95.5% subtype I and 90% subtype II achalasia patients had an Eckardt score ≤3. GERD occurred in 27.7% of all patients. Conclusion: A graded-protocol PD applied in the appropriate achalasia subtypes was shown to be a safe and highly effective approach, in both the short- and long-term. Competing Interests: Conflict of Interest: None (Copyright: © Hellenic Society of Gastroenterology.)
Databáze:	MEDLINE
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