Combined treatment of achalasia - botulinum toxin injection followed by pneumatic dilatation: long-term results

Autor: Jiří Dolina, Aleš Hep, Radek Kroupa, Vlastimil Válek, Z. Matyasova, I. Novotny, Jaroslav Sedmík, J. Mrázová, Jitka Prokešová
Rok vydání: 2010
Předmět:
Male
Achalasia
Esophageal Sphincter
Lower
Cohort Studies
0302 clinical medicine
Heartburn
Recurrence
Medicine
Longitudinal Studies
Prospective Studies
Botulinum Toxins
Type A
Prospective cohort study
Aged
80 and over
medicine.diagnostic_test
Gastroenterology
General Medicine
Middle Aged
Combined Modality Therapy
Dysphagia
Botulinum toxin
3. Good health
Treatment Outcome
Neuromuscular Agents
Patient Satisfaction
030220 oncology & carcinogenesis
Anesthesia
Female
030211 gastroenterology & hepatology
Esophagoscopy
medicine.symptom
Omeprazole
medicine.drug
Adult
medicine.medical_specialty
Manometry
Botulinum toxin injection
Catheterization
Young Adult
03 medical and health sciences
Humans
Aged
Esophageal Perforation
business.industry
Proton Pump Inhibitors
Long term results
medicine.disease
Endoscopy
Surgery
Esophageal Achalasia
Laparoscopy
Deglutition Disorders
business
Follow-Up Studies
Zdroj: Diseases of the Esophagus. 23:100-105
ISSN: 1442-2050
1120-8694
DOI: 10.1111/j.1442-2050.2009.01005.x
Popis: Injection of botulinum toxin (BT) and pneumatic dilatation are available methods in nonsurgical treatment of achalasia. Authors anticipate beneficial effect of prior BT injection on the success of pneumatic dilatation and duration of its effect. There are no long-term data available to assess efficacy of combined treatment. From 1998 to 2007, 51 consecutive patients (20 men and 31 women, age 24-83) with achalasia were included and prospectively followed up. Each patient received injection of 200 IU of BT into the lower esophageal sphincter (LES) during endoscopy and 8 days later pneumatic dilatation (PD) under X-ray control was performed. The follow-up was established every 3 months first year and then annually. The efficacy was evaluated by a questionnaire concerning patient's symptoms and manometry. Results were compared with 40 historical controls (16 men and 24 women, age 26-80) treated by PD alone using the same method and follow-up. Fifty-one patients underwent combined treatment. Four patients failed in follow-up and were not included for analysis. The mean duration of follow-up was 48 months with range 12-96 months. Thirty-four of forty-seven (72%) patients were satisfied with results with none or very rare and mild troubles at the time of the last visit. Forty-one patients were followed up more than 2 years. Effect of therapy lasted in 75% (31/41) of them. In 17 patients, more than 5 years after treatment, effect lasted in 12 (70%). Mean tonus of LES before therapy was 29 mm Hg (10-80), 3 months after therapy decreased to 14 mmHg (5-26). The cumulative 5 years remission rate (+/-95% CI) in combined treated patients 69% +/- 8% was higher than in controls 50% +/- 9%; however it, was not statistically significant (P= 0.07). In control group 1, case of perforation (2.5%) occurred. Eight patients (17%) with relapse of dysphagia were referred to laparoscopic Heller myotomy with no surgical complication. The main adverse effect was heartburn that appeared in 17 patients (36%). Initial injection of BT followed by PD seems to be effective for long-term results with fewer complications. But the combined therapy is not significantly superior to PD alone.
Databáze: OpenAIRE
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