Achalasia: 11-year retrospective review comparing symptomatic outcome and quality of life following Heller’s myotomy versus pneumatic dilatation of the oesophagus

Background: Acute cholecystitis carries a higher risk of subsequent gallstone related events than symptomatic, non-complicated disease. However, it is largely unknown to what extent non-operative treatment will affect the patient's well-being as no trial has studied the possible consequences on pain and quality of life. Our aim was to study in a randomized trial how observational treatment (watchful waiting) compared to cholecystectomy. Methods: Sixty-four patients with acute cholecystitis were randomized to observation or cholecystectomy. All gallstone related events were registered and patients answered questionnaires on quality of life (PGWB and NHP) and pain (Pain score and VAPS) at randomization and at 6, 12 and 60 months later. Results: Patients were followed-up for a median of 67 months. Ten of 33 patients (30 %, 95 % CI 15 %−46 %) patients randomized to observation and 27 of 31 (87 %, 95 % CI 75 %−99 %) of patients randomized to operation had a cholecystectomy. Twelve of 33 (36 %, 95 % CI 20 %−53 %) patients in the observation group had a gallstone related event compared to 6 of 31 (19 %, 95 % CI 5%−33 %) patients in the operation group, but the difference was not significant. When patients were grouped according to randomization or actual operative outcome (+/− cholecystectomy), we did not find any significant differences in pain or quality of life measurements. Conclusion: Although conservative treatment of AC carried a certain but not significantly increased risk of subsequent gallstone related events, this did not influence the symptomatic outcome as assessed by quality of life and pain measurements. Thus, we argue that conservative (non-operative) treatment and observation of AC is an acceptable option and should at least be considered in elderly and frail patients.

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Laparoscopic Heller’s Myotomy with Dor Wrap versus Pneumatic Dilatation in Treatment of Achalasia: A Prospective Randomized Study

Ain Shams Journal of Surgery ◽

10.21608/asjs.2016.178881 ◽

2016 ◽

Vol 15 (2) ◽

pp. 221-230

Author(s):

Gamal Fawzy ◽

Moheb Shoraby ◽

Hany Haroun Kaisar

Keyword(s):

Randomized Study ◽

Pneumatic Dilatation ◽

Prospective Randomized Study ◽

Heller’S Myotomy ◽

Heller's Myotomy

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Treatment Effects on the Quality of Life of Patients with Congenital Heart Disease: A Retrospective Review of 1,084 Patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1598975 ◽

2017 ◽

Vol 65 (S 02) ◽

pp. S111-S142

Author(s):

M. Boukovala ◽

J. Müller ◽

P. Ewert ◽

A. Hager

Keyword(s):

Quality Of Life ◽

Congenital Heart Disease ◽

Heart Disease ◽

Retrospective Review ◽

Congenital Heart ◽

Treatment Effects

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Accuracy of Achalasia Quality of Life and Eckardt scores for assessment of clinical improvement post treatment for achalasia

Diseases of the Esophagus ◽

10.1093/dote/doaa080 ◽

2020 ◽

Author(s):

Samuel Slone ◽

Ambuj Kumar ◽

John Jacobs ◽

Vic Velanovich ◽

Joel E Richter

Keyword(s):

Quality Of Life ◽

Predictive Validity ◽

Symptom Severity ◽

Medical Records ◽

Convergent Validity ◽

Pneumatic Dilatation ◽

Post Treatment ◽

Operating Characteristics ◽

Patient Reported

Abstract Achalasia Quality of Life (ASQ) and Eckardt scores are two patient-reported instruments widely used to assess symptom severity in achalasia patients. ASQ is validated and reliable. Although Eckardt is commonly used, it has not been rigorously assessed for validity or reliability. This study aims to evaluate (i) the accuracy of Eckardt and ASQ for assessing improvement post-treatment (predictive validity), (ii) accuracy of Eckardt and ASQ for assessing improvement post-treatment with pneumatic dilatation (PD) versus surgical myotomy (predictive validity), and (iii) convergent validity of Eckardt and ASQ tools. Patients with achalasia treated between 2011 and 2018 were eligible. Both instruments were administered by telephone. Treatment failure was determined by the review of medical records by two clinicians. The predictive ability of ASQ and Eckardt instruments in identifying treatment successes and failures was determined using receiver operating characteristics analysis and summarized as area under the curve (AUC). A total of 106 patients met inclusion criteria with 39 PD, 51 Heller myotomy, and 16 per-oral endoscopic myotomy. A review of medical records and esophageal testing revealed 13 failures (12%). AUC for Eckardt was 0.96 (95% confidence interval [CI] 0.87–0.99] and ASQ 0.97 (95% CI 0.92–0.99). The Eckardt cutoff 4, and ASQ, cutoff 15, were 94% and 87% accurate in identifying treatment successes versus failures, respectively. The correlation coefficient between the two tools was 0.85. In conclusions, (i) ASQ and Eckardt scores are valid and reliable tools to assess symptom severity in achalasia patients, (ii) both instruments accurately classify treatment successes versus failures, and (iii) the choice of tool should be informed by the physicians and patients’ values and preferences and repeat physiologic testing may be reserved for treatment failures with either instrument and patients classified, as treatment successes may be spared routine physiologic testing in the long term.

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