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Comparative Study
. 2014 Nov;29(6):738-45.
doi: 10.3904/kjim.2014.29.6.738. Epub 2014 Oct 31.

Long-term Outcomes of Balloon Dilation Versus Botulinum Toxin Injection in Patients With Primary Achalasia

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Free PMC article
Comparative Study

Long-term Outcomes of Balloon Dilation Versus Botulinum Toxin Injection in Patients With Primary Achalasia

Ho Eun Jung et al. Korean J Intern Med. .
Free PMC article

Abstract

Background/aims: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission.

Methods: We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire.

Results: Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012).

Conclusions: Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.

Keywords: Achalasia; Balloon dilation; Botulinum toxins.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Patient enrollment and treatment modalities. Botox, group of patients who underwent intrasphincteric botulinum toxin injection as a first-line therapy. BD, group of patients who underwent balloon dilation as a first-line therapy.
Figure 2
Figure 2
Treatment modalities and follow-up. Twenty-five patients underwent intrasphincteric botulinum toxin injection (Botox), and 12 underwent balloon dilation (BD) as initial therapy.
Figure 3
Figure 3
Kaplan-Meier curves for the symptom-fee period in patients undergoing intrasphincteric botulinum toxin injection (Botox) or balloon dilation (BD). A significant difference in the symptom-free period was observed between the Botox and BD groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036).

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