PNEUMATIC DILATION FOR ACHALASIA CARDIA: REDUCTION IN LOWER ESOPHAGEAL SPHINCTER PRESSURE IN ASSESSING RESPONSE AND FACTORS ASSOCIATED WITH RECURRENCE DURING LONG-TERM FOLLOW UP
| Autor: | Uday C Ghoshal, Murali Rangan, Asha Misra |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Myotomy
medicine.medical_specialty Receiver operating characteristic Long term follow up business.industry medicine.medical_treatment Gastroenterology Achalasia Balloon medicine.disease Internal medicine otorhinolaryngologic diseases Esophageal sphincter medicine Cardiology Balloon dilation Tears Radiology Nuclear Medicine and imaging business |
| Zdroj: | Digestive Endoscopy. 24:7-15 |
| ISSN: | 0915-5635 |
| DOI: | 10.1111/j.1443-1661.2011.01159.x |
| Popis: | Background: Data on utility of post-pneumatic dilation (PD) lower esophageal sphincter (LES) pressure measurement in evaluating short and long-term efficacy of dilation, which tears the non-relaxing LES in achalasia, are scanty. Methods: Post-PD LES pressure was measured in 72/98 patients with achalasia. The best cut-off pressure classifying responders and non-responders was determined by receiver operating characteristic (ROC) curve. Factors associated with non-response and recurrence were evaluated. Results: Of 98 patients (41.1 ± 13.3 years, 58 male), 75 improved, three had perforation requiring surgery, and 20 did not respond to the first PD session. Of 18/20 patients undergoing a second PD, 11 improved and six non-responders needed myotomy. 37/58 (71%) male and 17/40 (42.5%) female patients had a first PD with a 35-mm balloon (P = 0.03). Age and gender of patients did not influence outcome. LES pressure was lower in responders or in those having recurrence than in non-responders (17 mmHg [6.4–75], 11 mmHg [4.6–31]vs 25 mmHg [13–55]). On the ROC curve, 22.5 mmHg was the best cut-off value differentiating responders and non-responders (area under curve [AUC] 0.73). Of the 86 patients responding to PD, 20 had recurrence. Patients who responded to one session of PD or had LES pressure |
| Databáze: | OpenAIRE |
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