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

• Published in: Annals of gastroenterology 2022-01, Vol.35 (1), p.28-33
• Main Authors: Torresan, Francesco, Cortellini, Fabio, Azzaroli, Francesco, Ioannou, Alexandros, Mularoni, Cecilia, Shoshan, Dikla, Mandolesi, Daniele, De Giorgio, Roberto, Karamanolis, George, Bazzoli, Franco
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 1108-7471; 1792-7463; 1792-7463
• DOI: 10.20524/aog.2021.0683

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. 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. 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. 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.