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Meta-Analysis
. 2019 Jul;31(7):e13548.
doi: 10.1111/nmo.13548. Epub 2019 Jan 30.

Efficacy and Safety of Pneumatic Dilation in Achalasia: A Systematic Review and Meta-Analysis

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Free PMC article
Meta-Analysis

Efficacy and Safety of Pneumatic Dilation in Achalasia: A Systematic Review and Meta-Analysis

Froukje B van Hoeij et al. Neurogastroenterol Motil. .
Free PMC article

Abstract

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.

Keywords: achalasia; balloon dilation; efficacy; safety.

Conflict of interest statement

AB received research funding from Endostim, Medical Measurement Systems, Danone and given and received speaker and/or consulting fees from MMS, Astellas, AstraZeneca and Almirall. LP, FH, and AS have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of literature search, screening, and selection
Figure 2
Figure 2
Remission rates per article after 6 mo (left) and 12 mo (right) of follow‐up, comparing dilation up to 30, 35, and 40 mm
Figure 3
Figure 3
Remission rates per article after 6 mo (left) and 12 mo (right) of follow‐up, comparing studies that used a predefined dilation protocol (“Scheme”) with studies in which additional dilations were performed when symptom recurrence occurred (“Redilation”)

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References

    1. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313(18):1841‐1852. - PubMed
    1. Cheng P, Shi H, Zhang Y, et al. Clinical effect of endoscopic pneumatic dilation for achalasia. Medicine (Baltimore). 2015;94(28):e1193. - PMC - PubMed
    1. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238‐1249. - PubMed
    1. Hirano I. Pathophysiology of achalasia. Curr Gastroenterol Rep. 1999;1(3):198‐202. - PubMed
    1. Mikaeli J, Bishehsari F, Montazeri G, Yaghoobi M, Malekzadeh R. Pneumatic balloon dilatation in achalasia: a prospective comparison of safety and efficacy with different balloon diameters. Aliment Pharmacol Ther. 2004;20(4):431‐436. - PubMed

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