Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis
| Autor: | Leah I. Prins, Froukje B. van Hoeij, Arjan Bredenoord, André J.P.M. Smout |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
safety
medicine.medical_specialty Physiology efficacy Achalasia Review Article Balloon Esophageal Sphincter Lower Catheterization 03 medical and health sciences 0302 clinical medicine medicine Humans In patient balloon dilation Pneumatic dilation Endocrine and Autonomic Systems business.industry Gastroenterology medicine.disease Dilatation Surgery Esophageal Achalasia achalasia 030220 oncology & carcinogenesis Meta-analysis Esophageal sphincter Balloon dilation Dilation (morphology) 030211 gastroenterology & hepatology business |
| Zdroj: | Neurogastroenterology and Motility |
| ISSN: | 1350-1925 |
| Popis: | Background and Aims One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have been described with a varying balloon size, number of dilations, inflation pressure, and duration. We aimed to identify the most efficient and safe treatment protocol. Methods We performed a systematic review and meta‐analysis of studies on pneumatic dilation in patients with primary achalasia. Clinical remission was defined as an Eckardt score ≤3 or adequate symptom reduction measured with a similar validated questionnaire. We compared the clinical remission rates and occurrence of complications between different treatment protocols. Results We included 10 studies with 643 patients. After 6 months, dilation with a 30‐mm or 35‐mm balloon gave comparable mean success rates (81% and 79%, respectively), whereas a series of dilations up to 40 mm had a higher success rate of 90%. Elective additional dilation in patients with insufficient symptom resolution was somewhat more effective than performing a predefined series of dilations: 86% versus 75% after 12 months. Perforations occurred most often during initial dilations, and significantly more often using a 35‐mm balloon than a 30‐mm balloon (3.2 vs 1.0%); P = 0.027. A subsequent 35‐mm dilation was safer than an initial dilation with 35 mm (0.97% vs 9.3% perforations), P = 0.0017. Conclusions The most efficient and safe method of dilating achalasia patients is a graded approach starting with a 30‐mm dilation, followed by an elective 35‐mm dilation and 40 mm when there is insufficient symptom relief. The optimal pneumatic dilation therapy for untreated achalasia patients is a 30‐mm dilation, followed by an elective dilation to 35 and 40 mm in patients with persisting or recurrent symptoms. Dilation to 35 and 40 mm is relatively safe when it is preceded by a 30‐mm dilation. |
| Databáze: | OpenAIRE |
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